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Concussion
Neurological
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The below questions do not affect the results of your test:
Age
Race/Ethnicity
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Gender
Male
Female
Have you been diagnosed the following disorders:
Alzheimer’s Disease
Yes
No
Parkinson’s Disease
Yes
No
Sino-nasal Disease
Yes
No
Head Injuries/Concussion
Yes
No
Other neurological disorder
Yes
No
Do you have any family history of the following:
Alzheimer’s Disease
Yes
No
Parkinson’s Disease
Yes
No
Other Neurodegenerative
Yes
No
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Thank you!
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