Client Information

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Service Requested Select an option Physiotherapy Chiropractic Care Registered Massage Therapy Active Rehab ICBC / Motor Vehicle Accident Functional Movement Assessment Other

How did you hear about us? Select an option Google Ads Google Business Profile Google Organic Google Unknown Word of Mouth Hospital AHS / Case Manager Employee Referral Partner Referral Brochure Vehicle Other

Details

Neck Flexion

The ability to bring your chin to your chest.

Neck Flexion Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Neck Flexion Notes

Neck Extension

The ability to look up at the ceiling.

Neck Extension Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Neck Extension Notes

Neck Rotation

The ability to turn your head and look over your shoulder in both directions.

Neck Rotation Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Neck Rotation Notes

Shoulder Pattern 1

Reach down, behind your back, and touch the bottom of the opposite shoulder blade.

Shoulder Pattern 1 - Left Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Shoulder Pattern 1 - Left Side Notes

Shoulder Pattern 1 - Right Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Shoulder Pattern 1 - Right Side Notes

Shoulder Pattern 2

Reach up, behind your neck, and touch the top of the opposite shoulder blade.

Shoulder Pattern 2 - Left Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Shoulder Pattern 2 - Left Side Notes

Shoulder Pattern 2 - Right Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Shoulder Pattern 2 - Right Side Notes

Back Flexion

The ability to bend forward and touch your toes.

Back Flexion Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Back Flexion Notes

Back Extension

The ability to bend backwards with your back.

Back Extension Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Back Extension Notes

Back Rotation

The ability of your back and hips to turn in each direction.

Back Rotation - Left Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Back Rotation - Left Side Notes

Back Rotation - Right Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Back Rotation - Right Side Notes

Single Leg Stance

The ability of the body to stand on one leg.

Single Leg Stance - Left Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Single Leg Stance - Left Side Notes

Single Leg Stance - Right Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Single Leg Stance - Right Side Notes

Single Leg Squat

The ability of the body to perform a one-legged squat.

Single Leg Squat - Left Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Single Leg Squat - Left Side Notes

Single Leg Squat - Right Side Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Single Leg Squat - Right Side Notes

Overhead Squat

The ability to use the entire body in a complex movement.

Overhead Squat Assessment Select an option Normal Decreased Dysfunctional Movement Pain

Overhead Squat Notes