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Physiotherapy Manly

In Balance Physio Clinic

Patient Specific Functional Scale

Patient Specific Functional Scale

To assist with putting together and maintaining the best plan for you, we require a little info related to your issues and goals. We understand the impact of these issues will vary considerably between clients. The issues can be as severe as an inability to walk or as mild as stiff neck when sitting at the desk. Please try to pick 3 to 5 activities which are impacted by your issues and record them below. Rate your ability to perform them or their impact on your life, with zero being the worst and ten being the best.

  • Please Identify and Rate 3-5 Activities

  • Please identify an activity you are struggling with.
  • 1 being not too difficult 10 being very difficult
  • Please identify an activity you are struggling with.
  • 1 being not too difficult 10 being very difficult
  • Please identify an activity you are struggling with.
  • 1 being not too difficult 10 being very difficult
  • Please identify an activity you are struggling with.
  • 1 being not too difficult 10 being very difficult
  • Please identify an activity you are struggling with.
  • 1 being not too difficult 10 being very difficult
  • MM slash DD slash YYYY

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