NAME

CLIENT ASSESSMENT DIAGRAM

DATE

CHECKLIST  DETAILS CHECKLIST  DETAILS

‘X’ for “Quick Check” ‘X’ for “Quick Check”
Feet and Ankles: What makes better/worse?
Pain? Causal links?
Arthritis/Conditions? Visual irregularities?
Function? Excessive lordosis?
What makes better/worse? Anterior rotation?
Causal links? Client knows neutral?
Visual irregularities? Thoracic Spine/Shoulder:
Pronated? Pain?
Ab./Adducted? Arthritis/Conditions?
Condition of toes? Function?
Condition of plantar fascia? What makes better/worse?
Condition of calf muscles? Causal links?
Client knows neutral? Excessive kyphosis?
Knee: Protracted/Elevated scapula?
Pain? Internally rotated arms?
Arthritis/Conditions? Muscle tension?
Function? Client knows neutral?
What makes better/worse? Head and Neck:
Causal links? Pain?
Visual irregularities? Arthritis/Conditions?
Single leg squat? Function?
Patella tracking? What makes better/worse?
Client knows neutral? Causal links?
Lumbo–Pelvic Hip: Visual irregularities?
Pain? Forward head?
Arthritis/Conditions? Excessive neck curvature?
ANTERIOR VIEW Function? POSTERIOR VIEW Client knows neutral?

ADDITIONAL NOTES
Occupation/Activities
Injuries/Surgeries
Footwear Considerations
Major Deviations(s)
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