Get to know your balance…

Balance Conditioning Questionnaire

We can quickly identify your personal target areas for balance conditioning!
    Check all that apply
    (check if apply)
  • What type of aid and when you use it
  • How steady I feel...

    Please select the most accurate response below
  • Activity and Medical History

    If "Yes" or "Sometimes" please describe
  • Personal Benefit

  • So we can communicate with you about the class or send other relevant information. Nothing is shared with outside parties--ever.
  • This field is for validation purposes and should be left unchanged.