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Rehab Phase Assessment

Banora Chiropractic — Phase 2

Phase 2

Rehabilitation Phase Assessment

Track your functional recovery and goal achievement. Enter your name to begin.

Your full name

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Functional Ability

Step 1 of 4

Phase 2

Step 1 — Functional Ability25%

Rate your ability (1–5)

1 = cannot do at all 5 = fully able, no limitations

Walking 30+ minutes

Lifting / carrying

Sitting for 1+ hour

Bending forward

Sport / exercise

Pain at rest (0–10)

0 — None10 — Worst

2

Pain during activity (0–10)

0 — None10 — Worst

3

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Exercise Compliance

Step 2 of 4

Phase 2

Step 2 — Exercise50%

Your rehabilitation program

How consistently are you working on your rehab?

Exercise frequency

How is your exercise progression?

Getting easier — ready to progress Manageable — about right Difficult but doing them Too hard — need to modify

Any concerns about your exercise program?

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Goal Achievement

Step 3 of 4

Phase 2

Step 3 — Goal Achievement75%

How close are you to your goals?

Rate your progress toward each goal (0–100%)

Return to normal daily activities — 50%

Reduce pain to a manageable level — 50%

Return to work / sport — 50%

What's your biggest win since starting rehab?

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Maintenance & Future Health

Step 4 of 4

Phase 2

Step 4 — Future Health100%

Looking ahead

Planning for long-term health maintenance

Interest in ongoing wellness / maintenance care

Very interested Somewhat interested Not sure yet Not interested

Long-term confidence in managing your health — 7/10

LowHigh

Rate your overall experience (1–5 stars)

Would you recommend Banora Chiropractic?

Definitely yes Probably yes Not sure Probably not

Any other notes?

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Rehab Assessment

Assessment complete

Phase 2

⏳ Sending to clinic...

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Overall Rehab Score

Summary