TrueTurnPro Back Stabilization Assessment Questionnaire

Welcome to TrueTurnPro’s Back Stabilization program. Before you get started, please fill out our brief (14 questions) movement assessment questionnaire. The results from this questionnaire will categorize you as a Level 1, Level 2 or Level 3 exerciser. This will ensure that you are working out at an intensity that is appropriate for you. This is important in helping you to get the most out of using your TrueTurnPro.
Your Name*
Email*
What is your age?*
18-34 35-44 45-54 55-64 65+
If you are currently working out, how long have you consistently been exercising?*
I’m not currently participating in an exercise program Less than six months Six or more months
If you are currently working out, how many days per week do you participate in cardiovascular exercise for at least 20 minutes?*
I’m not currently doing any cardiovascular exercise 1-2 days/week 3-4 days/week 5-6 days/week
If you are currently working out, how many days per week do you participate in resistance training exercise?*
I’m not currently doing any resistance training 1-2 days/week 3-4 days/week 5-6 days/week
Can you get from a standing position to a lying position and back to a standing position without using your hands?*
Yes I had to use my hands a little I was able to get down but not back up I knew better than trying to attempt this
Do you currently have low back pain?*
Yes – Severe Yes – Moderate Yes – Minor Yes – Occasionally No
Has a doctor ever diagnosed you with high blood pressure?*
Yes No
Are you currently taking a prescription medicine for high blood pressure?*
Yes No
Have you ever had a orthopedic surgical procedure on your ....*
Yes No
Neck
Low Back?
Hips?
Have you ever had a orthopedic surgical procedure on your ....*
Yes No
Shoulders?
Knees?
Do you have any fused vertebrae?*
Yes No

TrueTurnPro Back Stabilization Assessment Questionnaire

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	Yes	No
Neck
Low Back?
Hips?

	Yes	No
Shoulders?
Knees?