Patient-Specific Functional Scale

Rate your difficulty with activities that are important to you (0 = able to perform, 10 = unable to perform)

Instructions:

Please add up to 5 activities that are important to your daily life, then rate your current difficulty with each activity on a scale from 0 (able to perform activity at same level as before injury or problem) to 10 (unable to perform activity).

Patient-Specific Functional Scale

Add activities and rate your difficulty

Type: ratings-list

Patient Watch Form - 3/20/2026