Baseline Concussion Testing Application

Neurology Centre of Toronto: Baseline Concussion Testing Application

Please complete the below application questions to qualify for participation in our Baseline Concussion Testing program. We look forward to working with you.

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* 1. First and Last Name

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* 2. Contact Phone Number

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* 3. Contact Email

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* 4. Name of Athlete Participating in Baseline Testing

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* 5. Birthday of Athlete Participating in Baseline Testing (Month, Day, Year)

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* 6. School/Sports Team of Athlete

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* 7. I confirm that the athlete participating in this program is 8 years or older.

Yes, the athlete participating in this program is 8 years or older.

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* 8. I confirm that the athlete participating in this program lives in Ontario, Canada.

Yes, the athlete participating in this program lives in Ontario, Canada.

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* 9. I confirm that the athlete participating in this program is able to come in person to the Neurology Centre of Toronto for their physical baseline testing assessment. The Neurology Centre of Toronto is located at 491 Eglinton Avenue West, Suite 100, Toronto, ON.

Yes, the athlete participating in this program is able to come in person to the Neurology Centre of Toronto for their physical baseline testing assessment