TBI ID Cards

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Caregiver Survey

TBI Identification Cards

* Indicates required field

AHIF recognizes that interactions between TBI survivors and First Responders can, at times, lead to issues of misunderstanding. To assist in communicating your unique situation as a TBI Survivor, AHIF is pleased to provide a free TBI Identification Card. Just complete the submit your answers to the questions below, and we will send you your personalized card.

How would you like your name to be listed? *

Who is your Emergency Contact? *

What is your relationship to your emergency contact? *

Parent Son Daughter Spouse Other

What is your Emergency Contact's phone number? *

What is most important for someone to know about you as a result of your injury? (Please check the three (3) most important items *

I might respond slowly to questions I might get confused from multiple questions at once My eyes might not focus on you while you are speaking to me I might have an unsteady walk I might become agitated or upset I might not be able to stand or walk I might need instructions repeated more than once I often am overstimulated by loud sounds and/or bright lights Other

If you selected "Other," please specify *

How would you recommend someone to most effectively communicate with you? (Please choose up to four options) *

Speak slowly and clearly Pause periodically to ask me if I understand Be prepared to repeat yourself Be patient with me, because it might take me a moment to respond Do not ask too many questions at once Other

If you selected "Other," please specify *

Thank you for taking time to complete this questionnaire. We will send your card to you as quickly as possible!

Submit

500 Chase Park South Suite 130 Hoover, AL 35244
Phone: (205) 823-3818 or 1-800-433-8002
Fax: (205) 823-4544
E-mail: info@ahif.org

Improving the quality of life for survivors of traumatic brain injury and for their families