Raw Score: This score is used to denote right and left side scoring. The right and left sides are scored in five
of the seven tests and both are documented in this space.
Final Score: This score is used to denote the overall score for the test. The lowest score for the raw score (each side) is
carried over to give a final score for the test. A person who scores a three on the right and a two on the left would receive
a final score of two. The final score is then summarized and used as a total score.
Clearing Test: A positive indicates pain. A negative indicates no pain. If pain is present (+),the score for that test would
result in a 0.
FUNCTIONAL MOVEMENT
SCREEN SCORE SHEET
ADDRESS:
SCHOOL/AFFILIATION:
HEIGHT: WEIGHT: AGE: GENDER:
PRIMARY SPORT: PRIMARY POSITION:
HAND/LEG DOMINANCE:
TEST
DEEP SQUAT
TOTAL SCREEN SCORE
HURDLE STEP
INLINE LUNGE
SHOULDER MOBILITY
SHOULDER CLEARING TEST
FLEXION CLEARING TEST
ACTIVE STRAIGHT-LEG RAISE
TRUNK STABILITY PUSHUP
EXTENSION CLEARING TEST
ROTARY STABILITY
L
L
L
L
L
L
R
R
R
R
R
R
+/-
+/-
+/-
+/RAW
SCORE FINAL SCORE COMMENTS
PREVIOUS TEST SCORE:
NAME: DATE: DOB:
CITY, STATE, ZIP: PHONE: