Senior Fitness Functional Assessment

Personal Information

Full Name Date of Birth Age Assessment Date

Medical & Health History

Relevant Medical Conditions Medications Assistive Devices Used

Functional Assessment

Test	Result	Notes
Chair Stand Test (30 sec.)
Arm Curl Test (30 sec.)
2-Minute Step Test
Chair Sit-and-Reach
Back Scratch Test
8-Foot Up-and-Go
Balance Test

Summary & Recommendations

Observations Recommendations