Biceps Reflex Assessment Form
Complete this form to record a biceps reflex assessment with clear, structured findings.
Patient and Exam Context
Patient identifier / label
*
Date of assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor name or role
*
Assessment setting / location
Side being assessed
*
Left
Right
Both
Biceps Reflex Assessment
Reflex Grade by Side
*
Rows
0 Absent
1+ Diminished
2+ Normal
3+ Brisk
4+ Very Brisk
Left
1
2
3
4
5
Right
6
7
8
9
10
Response Symmetry
*
Symmetric
Mildly Asymmetric
Clearly Asymmetric
Observed Response Quality
Prompt and well-defined
Delayed
Weak
Exaggerated
Spread beyond expected area
Required reinforcement
Other
Clinician Interpretation / Notes
Follow-up Notes
Follow-up recommendation
*
No follow-up needed
Repeat assessment
Refer for further evaluation
Other
Additional comments
Submit
Should be Empty: