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Patient Portal Link

Concussion Management Clinic

Fort Wayne Medical Education Program ImPACT
Online Referral

The Fort Wayne Family Medicine Center offers Post Concussion Management services to high school age athletes, under the care of an athletic trainer, who have had a ImPACT baseline test administered pre-incident.

If your team coach, doctor or athletic trainer determines you have a concussion and need to have a post concession assessment with our professional Concussion Management team, please fax this form to the number above and someone on our dedicated staff will call you to schedule an appointment on a first come first serve basis.



  Yes   No (baseline assessment is required for this program)

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