Healthcare Straight Up Fall Risk Quiz

Name *

Are you a female?

Yes

No

Clear selection

Have you had a fall in the last year? *

Yes

No

Are you above 75? *

Yes

No

Do you ever feel unsteady on your feet or feel as if you may fall? *

Yes

No

Do you have any numbness in your feet? *

Yes

No

Do you have any urgency when needing to use the bathroom? *

Yes

No

Have you had to use a walker or a cane in the last 6 months? *

Yes

No

Are you on any blood pressure medicine or opioids? *

Yes

No

Do you ever need to use the furniture for support when walking around your house? *

Yes

No