Contact Information

Anything pre-entered above may have been stored as a cookie on your computer to save you re-typing it. We do not use cookies to store any medical or other personal information.

Please select one answer to each question. Remember your answers are not an assessment of your physical capability – you should answer whether you can be motivated to complete the task on a bad day i.e. Will you do it NOT Can you do it ….?

1. Preparing Food

2. Taking Nutrition

3. Managing therpay or monitoring a health condition

4. Washing and bathing

5. Managing toilet needs or incontinence

6. Dressing and undressing

7. Communicating

8. Reading and understanding signs, synbols and words

9. Engaging with other people face to face

10. Maing budgeting decisions

11. Planning and following journeys

12. Moving around