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Brain Screener Questionnaire

Brain Assessment Screener

Please click in the column that best describes each item…

Almost Never (0)Sometimes (1)Often (2)
Experiences aches and pains or headaches
Become easily tired or have low energy
Distracted Easily
Feel sad, unhappy
Feel irritable, angry
Difficulty falling asleep and/or staying asleep
Forget names of people or things
Racing thoughts
Disorganized
My thinking ability seems slower than usual
My reaction time seems slower than normal
My concentration is worse than it used to be
Anxiety or feeling nervous
Trouble finding the right word or using the wrong word
Tremors or shaking
Loss of interest in some activities I previously found interesting
Trouble reading (cannot understand what you read)
TOTAL SCORE

How Did You Do?

  • 5 or Less is Normal - Getting a Personal Baseline score may be helpful
  • 6 to 8 is Moderate - BAIT Assessment is Recommended
  • 9 & Above is Severe - BAIT Assessment is Strongly Recommended

Your Score

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