Head Injury Form

If there was an impact to your head - please use this diagram to show ‘where’ on your head. Use the marks shown below to provide details.
(please take some time and be as accurate as possible)

Please click and use these above markings to show what happened to your head on the day of injury.

If you are not able to fill the diagram form online, please download the diagram, print it and add the markings over it.

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