What activity is right for me?
This is an activity assessment tool to determine what community class/activity may be right for you, based upon your current levels of mobility, strength and balance.  Its important that you tally up your scores upon answering each question as you move through this assessment.  This is because at the end of this questionnaire, your final score will determine as to what activity is most recommended for you.  Therefore, make sure that you have a pen and paper handy to log down the points that correspond to each answer you give. The form does not calculate your total points for you, so you will need to do this manually.

Please answer honestly and feel free to repeat the assessment in the future.  Your score may change in the future, as your health or fitness does and therefore a different class/activity may be more suited to you at various times.  In fact, it is actively encouraged to repeat this assessment frequently to ensure that you are attending a class that benefits but also challenges you.

Should you want a member of the Active Lifestyles team or specialist instructor to contact you with regards to helping you find the right class/activity locally, please let us know at the end of the questionnaire by adding your name and contact name/email in the comment box. 

Have you got a pen and paper handy?  If so, let's begin...........!
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1.  How concerned are you about losing your balance and falling, when doing any of the activities listed below?

Please answer each question in each row.  Each response is allocated a number of points.  Total up these points and keep a note of them.  You will need to make a note of your total points scored before moving onto the new question.
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Not at all concerned (1 point)
Somewhat concerned (2 points)
Fairly concerned (3 points)
Very concerned (4 points)
Getting dressed or undressed
Taking a bath or shower
Getting in and out of a chair
Going up and down stairs
Reaching for something above your head or on the ground
Walking up or down a slope
Going out to a social event
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