OPUSPEQ | dfwop

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OPUS LE Functional Status Measure

Please read the following questions and answer to the best of your ability. After completion of all questions, please press the submit button at the bottom of the page. Thank you

How easy, or difficult is it for you to do the following?

Do you typically wear an orthotic or prosthetic device to perform this activity?

Question 1 *

No

Yes

Question 2 *

No

Yes

Question 3 *

No

Yes

Question 4 *

No

Yes

Question 5 *

No

Yes

Question 6 *

No

Yes

Question 7 *

No

Yes

Question 8 *

No

Yes

Question 9 *

No

Yes

Question 10 *

No

Yes

Question 11 *

No

Yes

Question 12 *

No

Yes

Question 13 *

No

Yes

Question 14 *

No

Yes

Question 15 *

No

Yes

Question 17 *

No

Yes

Question 16 *

No

Yes

Question 18 *

No

Yes

Question 19 *

No

Yes

Question 20 *

No

Yes

1721 W Plano Pkwy Ste 212

Plano, TX 75075

Phone: 469.931.2177

Fax:469.596.0397

Hours of Operation

Monday-Friday: 9am-5pm

Closed for Lunch 12-1pm

Closed Saturday & Sunday

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