Illinois Department of Human Services Brain Injury Survey
Identification
1.
What city/town do you live /serve?
2.
What County do you live/serve?
3.
What type of area is it?
Urban
Rural
4.
You are taking this survey as a. (choose on of the following)
Person with brain injury
Parent
Child
Service Agency
Medical Institution
Spouse/Significant Other
Personal Assistant
State Agency
Vendor / Product Services
Case Management Agency
Veteran
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