Our Fall Risk Self-Test is an important “first step” in assessing your risk level to experience a first-time fall or a recurring fall. Please consult with your primary physician or health care provider once you have completed the test to determine your point score, level of risk for falling and recommended fall prevention interventions.
Circle “Yes” or “No” for each statement below.
- Yes (2) No (0) I have fallen in the last 6-12 months.
- Yes (2) No (0) I use or have been advised to use a cane or walker.
- Yes (2) No (0) I have floor clutter and limited pathways at home.
- Yes (1) No (0) Sometimes I feel unsteady when I walk.
- Yes (1) No (0) I steady myself by holding onto furniture at home.
- Yes (1) No (0) I have anxiety that I will fall.
- Yes (1) No (0) I need to push with my hands to stand up from a chair or bed.
- Yes (1) No (0) I have some trouble stepping up to a curb or step.
- Yes (1) No (0) I often have to rush to the bathroom.
- Yes (1) No (0) I have lost some feeling in my feet.
- Yes (1) No (0) I take medication that sometimes makes me lightheaded, dizzy or tired.
- Yes (1) No (0) I take medication to help me sleep, reduce anxiety or improve my mood.
- Yes (1) No (0) I often feel sad or depressed.
Total Score ____.
1. Add up the number of points for each “Yes” answer. This combined number is your Total Score.
2. If you scored (4) points or more, you may be at risk for falling.
3. If you scored (6) points or more you are at a higher potential risk of falling.
4. Consult with your physician or health care provider for the proper fall prevention strategies (see our free Home Kit) commensurate with your scoring.
“I am very uneasy and have had many falls after my surgery. Ordering the First Response system was easy and I even set it up myself. I have had to use my alert button a few times so far. My daughter has even been contacted after I had taken a few falls. My First Response system has worked great each time I’ve needed it!”