Needs Assessment Survey
Welcome to the BIC Needs Assessment Survey
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The purpose of this study is to assess the needs of people living with a brain injury.

This study will provide information about the needs of the brain injury community, and will help determine how the BIC may best be used to help those whose lives have been affected by brain injury.

Results will be available to those who provide programs, services, or products to the brain injury community, and will encourage those providers to spread the word and help them address the needs of this community.  Results will be updated regularly on the BIC website.

This survey typically takes between 20-30 minutes to complete.  (Please be sure you are well-rested and use any accommodations necessary.)

If you are unable to participate in the online version, you can download the printable version. 

When you’ve completed the downloaded survey, please mail it to:

Brain Injury Connection
Attention:  Survey Committee
PO Box 2452
Alameda, CA  94501

The only anticipated risk from participation is distress over recollection of brain injury.

Participation is voluntary, and participants may withdraw from the survey at any time. Participants must be at least 18 years of age, or have someone over the age of 18 complete the survey for them.  Participants must have sustained a brain injury, or be answering for someone who has, in order to participate.

Dr. Matthew Harris developed the BIC survey.  He serves on the BIC Board of Directors and is a neuropsychologist with a passion for clinical work helping those with brain injury. He also has expertise and experience in statistics and research methods, and used those skills to help design this survey and to analyze the results.

If you have any questions, about this survey contact Dr. Matthew Harris or Debi Palmer by clicking on the link of the person you wish to contact, click on CONTACT US and click on Dr. Harris or Debi Palmer and fill out the form, or go to the Main Menu above and choose CONTACT US.


Informed Consent*
I agree to participate in the BIC Needs Assessment Survey. I have read the description above and understand that I may withdraw from the survey at any time. I have not taken this survey before and I am at least 18 years of age or have my parent/legal guardian's consent to participate.
I agree