Assessment
First Name
*
Last Name
*
Date
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Postural Assessments
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Head Forward
Head Tilt
Head Rotation
L Shoulder - Rounding
L Shoulder - Adduction
L Shoulder - Dropping
L Shoulder - Elevated
R Shoulder - Rounding
R Shoulder - Adduction
R Shoulder - Dropping
R Shoulder - Elevated
Anterior Pelvic Tilt
Posterior Pelvic Tilt
L Foot - Inversion
L Foot - Eversion
R Foot - Inversion
R Foot - Eversion
Movement Analysis
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OH Squat - Core Weakness
OH Squat - Lats Tightness
OH Squat - Elbows Bending
Lunges - L hip/knee/ankle - IR
Lunges - L hip/knee/ankle - ER
Lunges - R hip/knee/ankle - IR
Lunges - R hip/knee/ankle - ER
Row - L Scapulas - Elevation
Row - L Scapulas - Poor Retraction
Row - R Scapulas - Elevation
Row - R Scapulas - Poor Retraction
Pushups - Lumbar Overextension
Pushups - Scapulas Asymmetry
OH Press - No Full ROM
OH Press - Pain w/ ROM
Flexibility Assessment
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L Piriformis/Medial Glute - Pass
L Piriformis/Medial Glute - NI
R Piriformis/Medial Glute - Pass
R Piriformis/Medial Glute - NI
L Ankle Mob - Pass
L Ankle Mob - NI
R Ankle Mob - Pass
R Ankle Mob - NI
L Hamstrings - Pass
L Hamstrings - NI
R Hamstrings - Pass
R Hamstrings - NI
L Adductors - Pass
L Adductors - NI
R Adductors - Pass
R Adductors - NI
I's - Pass
I's - NI
Y's - Pass
Y's - NI
L Shoulder ER - Pass
L Shoulder ER - NI
L Shoulder IR - Pass
L Shoulder IR - NI
R Shoulder ER - Pass
R Shoulder ER - NI
R Shoulder IR - Pass
R Shoulder IR - NI
L Quads - Pass
L Quads - NI
R Quads - Pass
R Quads - NI
Fitness Testing - List any here
*
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