This questionnaire is a great tool to evaluate your risk of falling. The modified falls efficacy scale is a visual analog scale where the subject is asked to rate there confidence performing a task from zero to ten.Instructions to Participants:Subjects are asked, “How confident/sure are you that you can do each of the activities without falling?”Instructions for Scoring:The modified falls efficacy scale is a visual analog scale in which items are scored from 0 to 10, with 0 meaning “not confident/not sure at all,” 5 being “fairly confident/fairly sure,” and 10 being “completely confident/completely sure.” *Hill KD, Schwarz JA, Kalogeropolous AJ, Gibson, SJ. Fear of Falling Revisited. Arch Phys Med Rehabil. 1996;77:1025-1029.Please note this information is strictly confidential.