OBISSS Interest Form

NASHIA’s OBISSS is an online screening system designed to identify both a history of brain injury and any current challenges that may be linked to such injuries. This dual focus allows for a more comprehensive understanding of an individual's situation. Knowing about a past brain injury is valuable, but understanding the ongoing impact on daily life is crucial for providing appropriate support.

The OBISSS platform is primarily designed to be self-administered online. This format increases the accessibility and convenience of the tool for individuals in various settings. Users can complete the screening independently or with assistance from a provider or loved one if needed.

Right now, we are currently working on a pilot project with governmental offices and organizations in Anne Arundel County with a plan to move it statewide once we get additional funding and find other partners.

Since we may be able to expand this ongoing pilot program, we encourage you to express your interest on the form below in order for us to determine additional demand for this incredibly valuable and powerful tool for brain injury recovery.

If you need more information, or would like to discuss your particular situation, please contact us at 800.221.6443 or info@biamd.org.

Full Name*

First NameLast Name

I am:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

E-mail

I prefer to be contacted by*

PhoneEmail

I am looking for (select all that apply)

Information and ResourcesOther

I learned about this opportunity to participate in OBISSS through:

Any other information you feel we need to know before we follow up:

By submitting this form, you are agreeing that BIAMD may use the information in this form to contact you for purposes of setting up your ability to utilize the OBISSS tool or provide additional information and resources.

Online Brain Injury Screening and Support System (OBISSS) Interest Form