Brain Connect

Hi there! Welcome to the Brain Injury Association Waterloo-Wellington's Brain Connect program!

In response to the Covid-19 pandemic, we know that many brain injury survivors are isolated and need to rely on technology to stay connected with family, friends and professional services. We also know that many of you may need to learn how to use what you have or need an upgrade! Our Brain Connect program (sponsored by KW Community Foundation) is a short-term project to support our members in the Waterloo Region to utilize technology to enhance their lifestyle and rehabilitation journey.

Please help us identify technology solutions that meet your needs by filling out the questionnaire below. While we can't promise we will be able to meet all of the requests or meet all of your goals, we will focus on helping improve your quality of life through exploring the many benefits of technology in everyday life.

Name*

First NameLast Name

E-mail*

example@gmail.com

Phone Number*

On a scale of 1 to 10 how do you rate your skill level with using technology?

	1	2	3	4	5	6	7	8	9	10

1 is Not a clue!, 10 is Tech wiz!

What devices do you currently own?*

What devices are you interested in learning about?*

If you have a smartphone or a tablet do you download apps?

YesNo

What goals do you hope to acheive through technology?*

Communicate with family/friends (Email, phone, video, social media)Access information (Surf the web, research, shop, learn)Organization/time management (Reminders, timers, alarms, calendars)Improve cognitive functioning (memory, attention, concentration)Improve independence both in home and in the community (fall detection montioring, GPS navgivation, video doorbells)Improve lifestyle through applications/add-ons (blue light filter for screens, speech to text dictation)Become more comfortable and savy with technology.Other

What are your biggest concerns around using new/exisiting technology

Type/write a short response into the box.

Brain Injury Association Waterloo – Wellington

Thank you for taking the time to complete this questionnaire, we will be in touch with you soon!