Brain Injury Contact Survey

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The Virginia Department for Aging and Rehabilitative Services (DARS) is conducting a statewide Brain Injury Needs & Resources Assessment with Virginians who have a brain injury, their family members / caregivers, and individuals and organizations that provide services to this community. As part of this effort, the Survey and Evaluation Research Laboratory (SERL) at Virginia Commonwealth University is assisting DARS in collecting information from these three groups, including service needs and gaps, as well as available resources. As an individual with a brain injury, a family member / caregiver of an individual with a brain injury, or as a service provider, you may be eligible to participate in this data collection. For the purposes of this survey, if you are an individual, organization, or other for-profit or nonprofit entity which provides services to people with a brain injury, either as your primary target audience or indirectly (e.g., people with dual diagnoses), you are considered a service provider.

Examples of events that MAY cause a brain injury include:

1) Vehicle Crash

2) Assaults

3) Falls

4) Bicycle Injury

5) Sports Injury

6) Combat Related Injury

7) Brain Aneurysm

Information provided through the completion of the survey will help DARS and other brain injury providers plan and promote appropriate service delivery for survivors and their family members / caregivers. Your responses will be confidential – information will be reported in the aggregate only (no individual data will be released). If you have any questions, please contact Jennifer Reid of VCU’s SERL at 804-827-0459.

Would you like a survey to be mailed to you or would you like a link to the survey to be sent to you by email?

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Name:

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Caregiver

Survivor

Both (Caregiver and Survivor)

Service Provider

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Yes

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Please enter the second address where you would like a survey mailed:

Name:

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Both (Caregiver and Survivor)

Service Provider

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Yes

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Please enter in the email address you would like a survey link sent to:

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Both (Caregiver and Survivor)

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.