MODIFIED SCORE SHEET

MODIFIED FUNCTIONAL MOVEMENT

SCREEN SCORE SHEET

NAME: DATE: DOB:

ADDRESS:

CITY, STATE, ZIP: PHONE:

SCHOOL/AFFILIATION:

HEIGHT: WEIGHT: AGE: GENDER:

PRIMARY SPORT: PRIMARY POSITION:

HAND/LEG DOMINANCE: HAND LENGTH: PREVIOUS TEST SCORE:

TEST RAW SCORE FINAL SCORE COMMENTS

DEEP SQUAT
L
+/-
ANKLE CLEARING TEST R
+/-
L Asymmetry:
LOWER BODY MCS
R Foot Length:

L
SHOULDER MOBILITY
R
L
+/-
SHOULDER CLEARING TEST R
+/-
L
ACTIVE STRAIGHT LEG RAISE
R
L

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