Beaches Osteopathic Centre Falls Questionnaire - Part 2 Please don't forget to download our FREE ebook "FIVE STEPS TO BETTER BALANCE” by clicking here Question Title * 1. Are you losing confidence in your balance? Not at all Slightly Moderately Severely Question Title * 2. Do you avoid going out as you're worried you might fall? Not at all Slightly Moderately Severely Question Title * 3. Do you find yourself needing to plan ahead on how to best get across a room? Not at all Slightly Moderately Severely Question Title * 4. Do you bump into things? Not at all Slightly Moderately Severely Question Title * 5. Do you use a: Walking stick Walker Wheelchair Other (please specify) Question Title * 6. If you thought that it might improve your balance and quality of life, would you be motivated to: Have a balance assessment Do 1 on 1 postural retraining Do a group execise Question Title * 7. Do you have any physical activity like to do? Golf Bowls Swimming Walking Other (please specify) Question Title * 8. Do you have any special hobbies you like to do? Gardening Travel Other (please specify) Question Title * 9. Do you read: The Senior Manly Daily Health page on Wednesdays Peninsula Living Pittwater Life Other (please specify) please list your favourite Question Title * 10. Do you regularly use: The internet Email Facebook Other (please specify) Done