Text or Call Us(770) 452-0022
Compass Family Chiropractic

Performance Index

Pre-Exam Health Survey — a quick snapshot of how easily your body is moving today.

Please do not complete this pre-exam health survey until requested to do so. Your care team will let you know when it's time. It takes about two minutes.

Your information

Rate your ability to perform each task

1 = no difficulty · 5 = extreme difficulty
1

Your usual hobbies, recreational, or sporting activities?

No difficultyUnable
2

Squatting?

No difficultyUnable
3

Lifting an object like a bag of groceries from the floor?

No difficultyUnable
4

Walking a mile?

No difficultyUnable
5

Going up or down 10 stairs (about 1 flight)?

No difficultyUnable
6

Standing for one hour?

No difficultyUnable
7

Sitting for one hour?

No difficultyUnable
8

Sleep?

No difficultyUnable
0 of 8 answered

Anything else we should know?

Your responses are sent securely to the Compass Family Chiropractic care team and are never shared.