Free SCAT6 Online Form | Auto-Scoring Concussion Assessment

Athlete Name:

ID Number:

Date of Birth:

Date of Examination:

Date of Injury:

Time of Injury:

Sex:

MaleFemalePrefer Not To SayOther

Dominant Hand:

LeftRightAmbidextrous

Sport/Team/School:

Current Year in School:

Years of Education Completed:

First Language:

Preferred Language:

Examiner:

Modified Balance Error Scoring System (mBESS)

Test the non-dominant foot. Each stance is held for 20 seconds. Record errors out of 10 for each stance.

Foot Tested:

LeftRight

(test the non-dominant foot)

Testing Surface:

Footwear:

Modified BESS (20 seconds each)

Double Leg Stance:

of 10

Tandem Stance:

of 10

Single Leg Stance:

of 10

Total Errors: 0 of 30

On Foam Optional

Perform foam assessment

Timed Tandem Gait

Place a 3-metre-long line on the floor with athletic tape. Please complete all 3 trials. Record time in seconds.

Trial 1 (sec)

Trial 2 (sec)

Trial 3 (sec)

Average

Fastest

Dual Task Gait Optional

Walk heel-to-toe while counting backwards by 7s. Record time (sec) and counting errors for each trial.

Practice (starting at 93):

Errors:

Time (sec):

Trial 1 (starting at 88):

Errors:

Time (sec):

Trial 2 (starting at 90):

Errors:

Time (sec):

Trial 3 (starting at 98):

Errors:

Time (sec):

Fastest Dual Task Time: - sec

Were any single- or dual-task, timed tandem gait trials not completed due to walking errors or other reasons?

Assessment Summary

All sections included in this assessment

Demographics & Athlete Information
Concussion History
Step 1: Athlete Background
Step 2: Symptom Evaluation (22 symptoms)
Step 3: Cognitive Screening (Orientation, Memory, Concentration)
Step 4: Balance Examination (mBESS, Tandem Gait, Dual Task)
Step 5: Delayed Recall
Step 6: Decision & HCP Attestation

Scores are auto-calculated. Your progress is auto-saved to this browser.

SCAT Forms Suite

SCAT6™

SCOAT6™

Child SCAT6

Important Notes

SCAT6™ Assessment Form

SCAT6™

Athlete Information

Concussion History

Step 1: Athlete Background

Step 2: Symptom Evaluation

Step 3: Cognitive Screening

Orientation (1 point for each correct answer)

Immediate Memory

Concentration - Digits Backward

Months in Reverse Order

Total Cognitive Score

Step 4: Coordination and Balance Examination

Modified Balance Error Scoring System (mBESS)

Modified BESS (20 seconds each)

On Foam Optional

Timed Tandem Gait

Dual Task Gait Optional

Step 5: Delayed Recall

Step 6: Decision

Assessment Summary

SCAT Forms Suite

SCAT6™

SCOAT6™

Child SCAT6

Important Notes

SCAT6™ Assessment Form

SCAT6™

Athlete Information

Concussion History

Step 1: Athlete Background

Step 2: Symptom Evaluation

Step 3: Cognitive Screening

Orientation (1 point for each correct answer)

Immediate Memory

Concentration - Digits Backward

Months in Reverse Order

Total Cognitive Score

Step 4: Coordination and Balance Examination

Modified Balance Error Scoring System (mBESS)

Modified BESS (20 seconds each)

On Foam Optional

Timed Tandem Gait

Dual Task Gait Optional

Step 5: Delayed Recall

Step 6: Decision

Assessment Summary