Take Our General OT Needs Quiz

Take Our General OT Needs Quiz

Fill this short form out to assess your General OT needs:

Who is completing this Quiz? *

I am taking this quiz for myself

I am taking this quiz for someone else

First Name *

Last Name *

Phone *

Email *

Do you struggle with everyday tasks like dressing, bathing, cooking, or cleaning? *

Yes

Sometimes

Do you experience pain that makes it harder to complete daily routines? *

Yes

Sometimes

Do you feel more tired or weak during normal activities than you used to? *

Yes

Sometimes

Have you had an injury or surgery that still affects how you move or function? *

Yes

Do you avoid certain tasks because they feel unsafe, difficult, or overwhelming? *

Yes

Sometimes

Are you having trouble with balance, coordination, or walking confidence? *

Yes

Sometimes

Do you have difficulty getting up from the floor, bed, low chairs, or your car? *

Yes

Sometimes

Does your home setup make tasks harder than they need to be? *

Yes

Sometimes

Does clutter, poor setup, or limited space make you feel unsafe at home? *

Yes

Sometimes

Would guidance, adaptive equipment, or personalized training help you stay independent? *

Yes

Maybe

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