Instructions: Please complete the questionnaire to answer questions about the history of your neurological condition, your overall mobility, fall history, and concern of falling. Answer the questions to the best of your ability. It will take approximately 20 minutes to complete this questionnaire. The return of your completed questionnaire constitutes your informed consent to act as a participant in this research. If you have any questions or concerns about the questionnaire, you may contact Carolyn Da Silva, PT, DSc, NCS at 713-794-2087 or [email protected].