Name * First Name Last Name Email * I have fallen in the past year. Yes No I sometimes feel unsteady when walking. Yes No I worry about falling Yes No I take medications that make me dizzy or drowsy (e.g., blood pressure, sleep aids). Yes No I use a cane, walker, or hold onto furniture for support when walking. Yes No I have trouble getting up from a chair or bed Yes No I have vision problems that affect my balance Yes No If you answered “Yes” to any of the questions, you may be at risk of falling.Don’t wait until it’s too late — book your fall prevention screening today and take the first step toward staying safe, steady, and independent.
