Balance Self Test

Do you take medicine for two or more of the following medical conditions: heart disease, hypertension, arthritis, anxiety or depression?
Yes No

Do you feel dizzy or unsteady if you make sudden changes in movement, such as bending down or quickly turning?
Yes No

Have you experienced a stroke or other neurological problem that has affected your balance?
Yes No

Do you experience numbness or loss of sensation in your legs and/or feet?
Yes No

Are you inactive? (Answer yes if you do not participate in a regular form of exercise, such as walking 20-30 minutes at least three times a week.)
Yes No

Do you feel unsteady when you are walking or climbing stairs?
Yes No