Physical abilities Please make a selection for all questions

Are you able to:

1Dress yourself, including shoelaces and buttons?

2Get in and out of bed?

3Lift a full cup or glass to your mouth?

4Walk outdoors on flat ground?

5Wash and dry your body?

6Bend down to pick up clothing from the floor?

7Turn faucets on and off?

8Get in and out of a car?

9Walk two miles or three kilometers, if you wish?

10Participate in recreational activities and sports as you would like, if you wish?

Pain evaluation

0No pain

10Pain as bad as it could be

Health evaluation

0Very well

10Very poorly

Bring a copy of your latest RAPID3 results to each appointment. Email your results below.


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Password Resets, Login, Profile, Representative, Contact Us, Polls, Social Share, Doctor Discussion Guide, Dosing Guide, Symptom Checker, Knowledge Assessment, Event, More Info, Sign Up, Saving Card, Benefit Verification, Benefit Enrollments, Medical Exception, Injection Form, Share a Story

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Savings Card, Insurance, Symptom Journal, Test Score Tracker, Condition Information, Doctor Discussion Guide, Dosing Information, Enrollment Form, Flashcard, Medical Exception, Patient Counseling Guide, Savings Card, Symptom Journal, Doctor Discussion Guide, Doctor Search, Dosage Calculator, Enroll, Med Reminders, Quick Poll, Resource Request, Symptom Quiz, UGC Submission, Contact Rep, Savings Card, Social Share, App Store, More Info, Patient Resources, Share Information, Share Results, Submit a Story, Assessment Tool, Benefits Verification, Carousel, Initiation, Myth versus Fact, Workaround Quiz, Formulary Tool, Image Expand, Medical Exception, Q And A, Slider, Administration Instructions, Condition Information, Insurance, Inventory, Mechanism of Action, Patient Story, Product Overview, Program Overview, Injection Training, Other


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