Concussion Notification Form

When you have submitted this form, NZR and your local Provincial Union will:

  • provide support related to return to play and medical appointments.
  • send an email to notify the player, provincial union and school/club of the suspected concussion and process for return to play.

Please note: The Community Concussion Management Pathway is being trialled in Otago, Hawkes Bay, North Harbour and Wairarapa-Bush and our aim is to scale the programme nationwide in 2025.

Were any of these Red Flags present? (Please select all that apply)*

If the player reports any of these Red Flags, please get the player to A&E or urgent care immediately.

This concussion notification form is currently available to Otago, Hawkes Bay, North Harbour and Wairarapa-Bush. If you would like to report a suspected concussion outside of these regions please email

What is your relationship to the player? (Please select all that apply)*
Were any of the following signs or symptoms observed? (Please select all that apply)*
How did you find out about the suspected concussion? (Please select all that apply)