Record your Home Balance Test Results

Step 1: Two Feet on the Floor

Place both feet on the floor with your arms at your sides

1A Eyes Open

1B Eyes Closed

Step 2: One-Leg Balance Test - Eyes Open

One foot on the floor, one leg bent at 90 degrees, eyes open

2A Right Leg Up - Eyes Open

2B Left Leg Up - Eyes Open

Step 3: One-Leg Balance Test - Eyes Closed

One foot on the floor, one leg bent at 90 degrees, eyes closed

3A Right Leg Up - Eyes Closed

3B Left Leg Up - Eyes Closed

Please submit your results below and we'll contact you to schedule a balance consultation!

First Name

Last Name

Email *

Phone *

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