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* 1. I live in (city/county):

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* 2. I am currently living (check all that apply):

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* 3. It was difficult for me to find a place to live after I left the hospital:

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* 4. The reason it was so difficult for me to find a place to live after I left the hospital is:

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* 5. In what year was your injury?

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* 6. My injury can be described as (check one):

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* 7. The cause of my injury was:

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* 8. The severity of my injury can be described

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* 9. I understand what my brain injury is and how it has affected me:

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* 10. I feel that I was well informed of my injury by the healthcare professionals.

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* 11. The person(s) who helped me understand what my injury means are (check all that apply):

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* 12. I have healthcare through:

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* 13. My insurance covers most of my healthcare costs/needs:

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* 14. Were you contacted or offered any help or support from any agency following your injury?

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* 15. Would it have been helpful if somebody contacted you to help you to get back in the community?

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* 16. Since my injury I have been able to get what I need as a survivor:

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* 17. The services I am receiving/have received while living in the community are (check all that apply):

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* 18. I am satisfied with my services.

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* 19. Those who provide support to me/assist in everyday activities (check all that apply):

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* 20. After I had my injury, I was able to get resources to help me financially through (check all that apply):

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* 21. I am able to do the following activities by myself (check all that apply):

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* 22. For those activities listed in question 21, do you receive any assistance to help you perform these activities?

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* 23. I feel that my injury has affected my relationships with friends/family.

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* 24. My relationships have improved because I have (check all that apply):

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* 25. Before COVID-19, did you experience any isolation?

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* 26. I can get from one place to another by:

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* 27. Finding transportation is a difficult thing for me to do:

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* 28. I am currently employed:

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* 29. Do you want a job?

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* 30. Please share additional comments that you feel are important for us to know.

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* 31. Has anyone helped you to fill out this survey?

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