Progress

Your Details[ Edit ]Result:
Falls History[ Edit ]Result:
Medical Conditions[ Edit ]Result:
Other Medical Conditions[ Edit ]Result:
Nutrition[ Edit ]Result:
Enviroment[ Edit ]Result:
Gait and Physical Activity[ Edit ]Result:
Functional Assistance[ Edit ]Result:
Cognitive Test[ Edit ]Result:
Observed Behaviour[ Edit ]Result:

Initial stability assessment

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Caution: This is not a self-assessment. It should be performed by someone other than the person being evaluated. This can be a medical professional, carer, family member or friend.

Introduction

During the assessment, be observant of how aware the patient is of their abilities and surroundings.

As you work through the questionnaire there will be instructions and prompts to guide you on what to observe or say to the client.

Patient introduction

This assessment is designed to help us determine whether you are at risk of experiencing a fall. Having this information will enable your General Practitioner to put an appropriate prevention plan in place.

We will provide you with a report for your GP based on your answers. Your results will also be used for ongoing research to better our understanding of how to reduce risk, improve intervention and help many others prevent a fall. Under no circumstances will personal information be shared.

Email Address

I consent to Sensokinetic collecting and using my results for research and communication in accordance with our Terms and Conditions and Privacy Policy.

Patient details

First name Last name Date of birth

Date of assessment Do you live at home or in an independent living community?

Do you live alone?

Do you have help from a family carer or home support service?

Is English your preferred language?

What is your preferred language?

Progress

Initial stability assessment

Introduction

Patient introduction

Patient details

Understand your limits