Sportable Wellness Assessment Athlete Name(Required) First Last PhoneEmail Length of Time Participated with Sportable(Required) InstructionsFor the 5 questions below, please mark the answer that best matches your current feelings. All responses will be kept confidential.General Health(Required)In general, would you say your health is: Poor Fair Good Very Good Excellent Physical Health(Required)How satisfied are you with your physical health (strength, endurance, mobility, etc.)? Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Mental Health(Required)How satisfied are you with your mental health (self-esteem, coping, overall mood, etc.)? Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Social Health(Required)How satisfied are you with your social health (having meaningful relationships or friendships, social connection, and feeling sense of community)? Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Change in Quality of Life(Required)Since beginning participation with Sportable, how would you describe the change (if any) in activity limitations, symptoms, emotions, and overall quality of life, related to your disability? 1 - No change (or condition has got worse) 2 - Almost the same, hardly any change at all 3 - A little better, but no noticeable change 4 - Somewhat better, but the change has not made any real difference 5 - Moderately better, and a slight but not noticeable change 6 - Better, and a definite improvement that has made a real and worthwhile difference 7 - A great deal better, and a considerable improvement that has made all the difference
