SARC-F Sarcopenia Screening Questionnaire
Screen yourself for sarcopenia risk by answering the following questions. Please provide accurate information for best results.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Other
Contact Email (optional)
example@example.com
Strength: How much difficulty do you have in lifting and carrying 10 pounds (about 4.5 kg)?
*
None
Some
A lot
Unable
Assistance in Walking: How much difficulty do you have walking across a room?
*
None
Some
A lot, or use aids
Unable without help
Rise from a Chair: How much difficulty do you have transferring from a chair or bed?
*
None
Some
A lot, or need help
Unable without help
Climb Stairs: How much difficulty do you have climbing a flight of 10 stairs?
*
None
Some
A lot, or use aids
Unable
Falls: How many times have you fallen in the past year?
*
None
1-3 falls
4 or more falls
Have you experienced unintentional weight loss (more than 5% of your body weight) in the last year?
Yes
No
How often do you engage in physical activity or exercise per week?
Please Select
Never
1-2 times
3-4 times
5 or more times
Submit Screening
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