Concussion SCAT Assessment Form
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Concussion SCAT Assessment Form
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The Concussion SCAT Assessment Form is based on the Sport Concussion Assessment Tool, the internationally recognized standard for evaluating athletes and individuals suspected of sustaining a concussion. This comprehensive form guides clinicians through a systematic multi-component evaluation including observable signs, symptom checklist, cognitive screening with orientation and memory testing, neurological screening, and balance examination using the modified Balance Error Scoring System (BESS).
The symptom evaluation section includes a 22-item graded symptom checklist where patients rate each symptom on a severity scale from 0 to 6, providing both a total symptom count and a cumulative severity score. The cognitive assessment covers orientation questions, immediate and delayed word recall, and concentration tasks. The neurological screen documents cervical spine assessment, coordination testing, and gait evaluation, creating a thorough clinical record of the patient's post-injury status.
Essential for sports medicine physicians, athletic trainers, emergency departments, urgent care centers, and concussion specialty clinics, this form supports evidence-based return-to-play and return-to-learn decision-making. It can be used for initial sideline assessment, serial monitoring during recovery, and comparison with baseline testing to guide safe and appropriate clearance for activity.
What's included
- 22-item graded symptom severity checklist
- Cognitive screening with orientation and memory tasks
- Modified BESS balance examination scoring
- Neurological screen including coordination and gait
- Red flag symptom identification and documentation
- Return-to-activity decision support and status tracking
Who uses this template
- Sideline concussion evaluation during sporting events
- Emergency department head injury assessment and documentation
- Serial concussion monitoring during recovery and rehabilitation
- Return-to-play and return-to-learn clearance evaluation
All form fields
16 fields across 3 pages. Customize any field after signing up.
How to use the Concussion SCAT Assessment Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Concussion SCAT Assessment Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Concussion SCAT Assessment Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 16 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Concussion SCAT Assessment Form HIPAA compliant?
Yes. All Formisoft templates, including the Concussion SCAT Assessment Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 16 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Concussion SCAT Assessment Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
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