Traumatic Brain Injury A to Z

What type of TBI did the Service Member/Veteran sustain? Check all that apply.:

Moderate

Severe

Penetrating

What is the current status of the Service Member/Veteran?:

Active Duty

Medically Retired

AD and awaiting MEB

AD and transitioning to VA

Veteran

What is the date of injury?:

What branch of the Service is/was the Service Member affiliated?:

In what location did the TBI take place?:

OCONUS combat related

OCONUS non combat related

Stateside

What was the mechanism of injury? Check all that apply.:

What is the Gender of the Service Member/Veteran?:

Male

Female

How old is the Service Member/Veteran?:

What is the relationship of the primary caregiver (receiving the guide) to the Service Member/ Veteran?:

Did the primary caregiver quit a job in order to care for the Service Member/Veteran?:

Yes

No

How old is the primary caregiver?:

What is the highest level of education completed by the primary caregiver?:

Less than 12 years

12 years

12-16 years

More than 16 years

Traumatic Brain Injury A to Z - FCC Distribution Report