What You're Getting Into

By typing your name in below, you are agreeing to the monthly cost of $50 per month and giving us permission to contact you via e-mail with your exercises. You understand that your monthly exercise program will auto-renew each month for up to 3 months unless you request to cancel your subscription. Subscriptions may be cancelled at anytime and you will only be responsible for the cost of the current month's program until the next billing cycle. 

Name *
Name
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Date

Patient Specific Functional Scale

Instructions: Please identify up to three important activities that you are unable to do or are having difficulty with as a result of your injury or problem. Today, are there any activities that you are unable to do or having difficulty with because of your injury or problem?  

0 = unable to perform activity // 10 = able to perform activity at the same level as before injury or problem
0 = unable to perform activity // 10 = able to perform activity at the same level as before injury or problem
0 = unable to perform activity // 10 = able to perform activity at the same level as before injury or problem
Name *
Name
Date *
Date

PSFS developed by: Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada, 47, 258-263.