Traumatic Brain Injury Survivor Questionnaire

Before answering the questionnaire, please read the following and proceed as directed.

This questionnaire is intended for Traumatic Brain Injury survivors who are 18 years of age or older. The purpose of the aforementioned questionnaire is to compile an overview of TBI Survivors. The questionnaire will address topics concerning the nature of your TBI, employed rehabilitation methods, daily-living activities, your state of mind, and general opinions of thoughts and emotions. When a certain amount of people have responded to the questionnaire, the results will be used to produce another questionnaire for non-TBI survivors, to identify any common misconceptions among the general population. Furthermore, the information compiled by this questionnaire may be used in different avenues of research concerning Traumatic Brain Injuries, along with inquiries into intervention and prevention strategies for the obstacles many Traumatic Brain Injury survivors encounter.

The questionnaire will take approximately one to two hours to complete and is strictly anonymous. The questionnaire is divided into seven sections, please note that it is acceptable to skip questions that you do not wish to answer.  The majority of questions will require short-answer responses with a few multiple-choice questions interwoven between them. You will have the option to partially complete the questionnaire and finish it at a later time.  If you choose to start and finish the questionnaire at a later time, you must SAVE the questionnaire using the button at the top right-hand corner of the screen.  If possible, we ask that you complete the questionnaire in its entirety no later than March 25th, 2017.  However, the questionnaire will be available beyond this date for an undisclosed period of time.

Participation in this questionnaire involves minimal risk; however, some questions may elicit fatigue. Please note, all responses are confidential, and no one individual will be identified based on their responses. Alternatively, all responses will be collected and analyzed in an aggregate form only. The questionnaire is entirely voluntary and withdrawing or refusing to complete this questionnaire involves no penalties or loss of benefits.

If you consent to take part in this study, please click the button below and proceed to the questionnaire. Questions regarding participant rights, or if you wish to lodge a complaint/concern can be directed to Ruth Galm, Human Protection Administrator, at (509) 359-6567 or by email at Any further questions about this study can be directed to the principle investigator, Nicholas Mehrnoosh at or the responsible project investigator, Jonathan W. Anderson, PhD, at

The purpose of this questionnaire is to assess the lives of TBI Survivors in hopes of ultimately educating the general population and thereby quelling any further discrimination, stigmas, and overall misconceptions about TBI.

Due to the possibility of fatigue, it is advised that you prepare yourself accordingly by allowing enough time and breaks for yourself.  Please attempt to complete the questionnaire in its entirety. However, if you are unable to complete the entire questionnaire that is completely understandable and any questions answered, even one, is helpful.

If you complete the questionnaire, you may contact the researchers to receive a packet regarding the results of this study when it’s complete.  An email will be provided at the end of the questionnaire, thank you.

There are 63 questions in this survey.

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