Make educated decisions about concussion care and treatment based on your patients’ test history and symptoms reporting.

Any trained healthcare provider can use a patient’s unique ImPACT Passport ID to get immediate access to their data. Complete the form below to be able to do so.

ImPACT Passport Program
ImPACT Passport allows anyone who has taken an ImPACT neurocognitive test to grant access to their baseline and post injury test results, record symptoms and locate a care provider….anytime, anywhere. Using the patient’s Passport ID, a Passport Trained health care provider can access the patient’s testing and symptom inventory. Passport opens the door to new patients for you and it’s free!
Name*
First Last
Email*
.
Account Number*
5 or 6 digits**
License Title*
License Number*
State / Province / International*
Criteria*
You must meet one of following criteria to be eligible to access ImPACT Passport: I am licensed in the state I am currently practicing in AND (you must select one):
- A licensed healthcare professional authorized to make return to play decisions under applicable state law; or
- A licensed or certified healthcare professional trained in the evaluation and management of concussions who is affiliated with a licensed healthcare professional authorized to make return to play decisions under applicable state law; or
- A licensed psychologist who has received neuropsychological training in the evaluation and management of concussions or who is affiliated with a licensed healthcare professional authorized to make return to play decisions under applicable state law.
ImPACT Passport Terms & Conditions
Disclaimer: ImPACT Passport is available only to licensed healthcare providers permitted to make return to play and return to activity decisions in the state in which such healthcare provider maintains a license. By accessing ImPACT Passport you represent and warrant to ImPACT Applications, Inc. and its affiliates (“ImPACT Applications”) that you are legally permitted under applicable law to provide testing services and make return to play or return to activity decisions in the state in which you are licensed. You further represent and warrant all information you provide to ImPACT Applications is true, accurate and complete and agree to immediately inform ImPACT Applications of any change in the information you provide. Providing ImPACT Applications with true, accurate and complete information is an essential condition to ImPACT Applications granting you access to ImPACT Passport. In the event the information you provide ImPACT Applications is not or becomes untrue, inaccurate and/or incomplete ImPACT Applications reserves the right to immediately cease providing you access to ImPACT Passport and other ImPACT Applications products and services. You acknowledge and agree ImPACT Applications has not and does not provide any opinion or guidance regarding laws applicable to your country, state or locality and/or licensed profession. You agree to indemnify, defend and hold ImPACT Applications its affiliates, directors, officers, shareholders, agents, successors and assigns harmless from any and all claims, obligations, losses, judgments, costs, and reasonable attorney and expert fees related to any claim that you engaged in unlawful activity, the unlicensed practice of medicine, the failure to maintain licensing status or any similar claims related to your use of ImPACT Passport. These representations, warranties and indemnities shall survive any suspension or termination of your access to ImPACT Passport.
*
- Check to confirm agreement with ImPACT Passport's Terms & Conditions?

** Customer Account Number can be found by: Login to the Customer Center, click “System Management”, click the organization you need the account number for.

ImPACT Passport Program
ImPACT Passport allows anyone who has taken an ImPACT neurocognitive test to grant access to their baseline and post injury test results, record symptoms and locate a care provider….anytime, anywhere. Using the patient’s Passport ID, a Passport Trained health care provider can access the patient’s testing and symptom inventory. Passport opens the door to new patients for you and it’s free!
Name*
First Last
Email*
.
Account Number*
5 or 6 digits**
License Title*
License Number*
State / Province / International*
Criteria*
You must meet one of following criteria to be eligible to access ImPACT Passport: I am licensed in the state I am currently practicing in AND (you must select one):
- A licensed healthcare professional authorized to make return to play decisions under applicable state law; or
- A licensed or certified healthcare professional trained in the evaluation and management of concussions who is affiliated with a licensed healthcare professional authorized to make return to play decisions under applicable state law; or
- A licensed psychologist who has received neuropsychological training in the evaluation and management of concussions or who is affiliated with a licensed healthcare professional authorized to make return to play decisions under applicable state law.
ImPACT Passport Terms & Conditions
Disclaimer: ImPACT Passport is available only to licensed healthcare providers permitted to make return to play and return to activity decisions in the state in which such healthcare provider maintains a license. By accessing ImPACT Passport you represent and warrant to ImPACT Applications, Inc. and its affiliates (“ImPACT Applications”) that you are legally permitted under applicable law to provide testing services and make return to play or return to activity decisions in the state in which you are licensed. You further represent and warrant all information you provide to ImPACT Applications is true, accurate and complete and agree to immediately inform ImPACT Applications of any change in the information you provide. Providing ImPACT Applications with true, accurate and complete information is an essential condition to ImPACT Applications granting you access to ImPACT Passport. In the event the information you provide ImPACT Applications is not or becomes untrue, inaccurate and/or incomplete ImPACT Applications reserves the right to immediately cease providing you access to ImPACT Passport and other ImPACT Applications products and services. You acknowledge and agree ImPACT Applications has not and does not provide any opinion or guidance regarding laws applicable to your country, state or locality and/or licensed profession. You agree to indemnify, defend and hold ImPACT Applications its affiliates, directors, officers, shareholders, agents, successors and assigns harmless from any and all claims, obligations, losses, judgments, costs, and reasonable attorney and expert fees related to any claim that you engaged in unlawful activity, the unlicensed practice of medicine, the failure to maintain licensing status or any similar claims related to your use of ImPACT Passport. These representations, warranties and indemnities shall survive any suspension or termination of your access to ImPACT Passport.
*
- Check to confirm agreement with ImPACT Passport's Terms & Conditions?

* Customer Account Number can be found by: Login to the Customer Center, click “System Management”, click the organization you need the account number for.