Personalized Matching Assesment

How steady does the person feel when transitioning from sitting to standing? Please select... Feels completely stable and balanced immediately Needs a moment to "find their feet" before moving Requires a firm surface or furniture to pull themselves up Experiences frequent swaying or dizziness upon standing What is the primary concern when moving through the home? How does the body respond to a short walk or physical task? Please select... Breathing and heart rate remain steady and comfortable Slight shortness of breath that recovers quickly with rest Noticeable fatigue, "heaviness" in the legs, or lightheadedness Occasional chest tightness or significant exhaustion after minimal effort What is the status of the person’s mobility aids (cane, walker, or rails)? Please select... Devices are professionally fitted, in good repair, and used correctly Devices show some wear (e.g., worn rubber tips) but are functional The person often forgets to use the device or uses it incorrectly No device is used despite frequent reaching for walls or furniture For those with limited mobility, have there been any changes to skin or swelling? Please select... Skin is clear and there is no unusual swelling in the limbs Mild swelling in the ankles by the end of the day Persistent redness or "hot spots" on heels, hips, or pressure points Significant swelling or skin discoloration that does not improve with elevation If a fall or health event occurred, what is the plan for calling for help?

When did the memory or thinking difficulties first begin? Please select... Gradually over several months or years Suddenly after a medical event After a head injury or accident Recently but not sure why What type of memory problems occur most often? Please select... Forgetting recent conversations or events Difficulty concentrating or focusing Trouble finding words while speaking Forgetting appointments or tasks Are there physical symptoms along with cognitive changes? Has the person experienced difficulty speaking or understanding speech? Please select... Yes, speech became difficult suddenly Yes, gradual word-finding difficulty Sometimes difficulty concentrating when speaking No speech problems How independent is the person in daily activities? Please select... Fully independent Needs occasional reminders Needs help with daily tasks Requires full-time support Have there been noticeable changes in personality or behavior? Please select... Increased confusion or agitation Mood swings or irritability after injury No significant changes Has the person experienced movement changes? Please select... Weakness or paralysis on one side Slower walking or balance issues Fatigue or dizziness after injury No movement issues

What led to the current change in movement or mobility? Please select... Suddenly after a medical event Following a surgery, fracture, or joint injury Gradually over several months or years Following a recent fall or accident Which parts of the body are primarily affected? (Select all that apply) How would you describe the person's current ability to walk? Are there challenges using the hands or arms for daily tasks? What is the primary sensation during movement? (Select all that apply) Which daily activities are currently the most difficult? (Select all that apply) None of the above

What best describes the person’s living situation? Please select... Lives alone Lives with family but spends most time alone Lives with a caregiver Lives in a community residence How often does the person interact socially with others? Please select... Daily interaction A few times per week Rarely Almost never What makes it difficult for the person to socialize? Please select... Mobility or physical limitations Memory or cognitive difficulties Lack of nearby friends or family Low mood or motivation What type of activities does the person enjoy? (Select all that apply) How comfortable is the person meeting new people? Please select... Very comfortable Somewhat comfortable Prefers familiar individuals Hesitant or anxious Does the person experience difficulty with memory or conversation? Please select... No difficulty Mild difficulty Frequent confusion How often does the person feel lonely or isolated? Please select... Rarely Sometimes Often Almost always