Falls Risk Assessment Tool

The Falls Risk Assessment Tool can help determine if you are at risk from falling, and provide advice and contact details of those who can help you.

To identify if you are at risk, please answer the following questions:

*Denotes required field.

Have you fallen in the past 12 months?*
Are you on 4 or more medications per day?*
Do you have Parkinson's disease or have you had a stroke?*
Do you feel unsteady / off balance?*
Do you struggle to get up from a chair?*
Contact details
Title*
First name*
Surname*
Telephone*
Mobile
Email*
Preferred method of contact
Disclaimer: Your details will be used by Agewell and may be passed onto third party. All information will be treated with strictest confidence. You can read our privacy policy here.

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