Functional Age Assessment — Longevity Optimization
Complete baseline and follow-up functional measures with safety screening for longitudinal comparison.
Client ID
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Assessment Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessment Timing
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Baseline
12-week reassessment
Event-driven reassessment
Grip Strength — Left (kg)
Grip Strength — Right (kg)
30-Second Chair Stand — Repetitions
Timed Up and Go — Time (seconds)
Balance Assessment — Protocol Used
Balance Assessment — Time Held (seconds)
Cardiorespiratory Fitness — VO2 max (mL/kg/min, measured or validated estimate)
If VO2 max unavailable: Standardized Submaximal Test Name
If VO2 max unavailable: Submaximal Test Result
Notes (limitations or test conditions)
Safety Screening: Has the client experienced any of the following since last assessment?
Chest pain with exertion
Fainting or near-fainting
Unusual shortness of breath
Recurrent falls
Rapid unexplained functional decline
If any safety item above is checked, medical review is required before exercise progression.
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