ABC Scale

  • MM slash DD slash YYYY
  • For each of the following activities, please indicate your level of self-confidence by choosing a corresponding number from the following rating scale:

    0% - No Confidence | 100% - Complete Confident

    How confident are you that you will not lose your balance or become unsteady when you…

  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • 0%10%20%30%40%50%60%70%80%90%100%
  • Today's Date: 10/04/2023
  • This field is for validation purposes and should be left unchanged.