Post-Concussion Symptom Scale (PCSS)

Post Concussion Symptom Scale

PCS Questionnaire
Participant Number*
Session Number*

Please rate the severity of each symptom listed below.

0- No Symptoms, 3- Moderate Symptoms, 6- Severe Symptoms
Headache*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Nausea*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Vomiting*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Balance Problems*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Dizziness*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Fatigue*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Trouble Falling Asleep*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Excessive Sleep*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Loss of Sleep*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Drowsiness*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Light Sensitivity*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Noise Sensitivity*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Irritability*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Sadness*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Nervousness*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
More Emotional*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Numbness*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Feeling "slow"*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Feeling "foggy"*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Difficulty Concentrating*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Difficulty Remembering*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Visual Problems*

1

2

3

4

5

6

1 is No Symptoms, 6 is Severe Symptoms
Should be Empty:

Post Concussion Symptom Scale