Rivermead Post-Concussion Symptoms Questionnaire (RPQ)

Please compare how you feel now with how you felt before the accident.

Your Information

Name

Date completed

Instructions

After a head injury or accident, some people experience symptoms that can cause worry or nuisance. Because many of these symptoms occur normally, please compare yourself now with before the accident. For each symptom, choose the number that most closely represents your answer over the last 24 hours.

0 = Not experienced
Not experienced at all.

1 = No more of a problem
No more of a problem than before the accident.

2 = Mild problem
A mild problem compared with before the accident.

3 = Moderate problem
A moderate problem compared with before the accident.

4 = Severe problem
A severe problem compared with before the accident.

Other Difficulties

Other difficulty 1

Other difficulty 2

Additional Notes

Did someone help you complete this form?

Comments about your symptoms or anything you want your care team to know

Results are automatically emailed to the clinic-designated assessment email after scoring.

Results

Interpretation note: RPQ-3 is the sum of the first 3 symptoms and RPQ-13 is the sum of the next 13 symptoms. Higher scores indicate greater post-concussive symptom severity. Symptoms are not specific to concussion alone and should be interpreted with clinical history and examination.