Adaptive Sports Athlete Functional Assessment Form
Athlete Information
Full Name
Date of Birth
Gender
Male
Female
Other
Sport
Classification
Disability/Impairment Information
Diagnosis
Date/Year of Onset
Type of Impairment
Physical
Visual
Intellectual
Other
Description
Functional Assessment
Mobility (ambulatory/wheelchair/assistive devices)
Upper Limb Function
Lower Limb Function
Trunk & Core Function
Coordination and Balance
Assistive Devices
Assistive Devices Used (e.g., wheelchair, prosthesis, orthosis, etc.)
Additional Notes & Recommendations