Independent Living Assessment

Do You or A Loved One Need a Medical Alert System – 15 Key Questions To Determine If You Are At Risk Now


As the leading authority on fall prevention and home safety for the medical alarm industry, First Response advises independent seniors and their family members who are considering a personal medical alert system for the first time, to complete our Independent Living Assessment. By answering 15 key questions, the answers provided will seek to identify the respondent’s level of risk, and whether an emergency medical alert system is needed.




Question #01: Are you or a loved one 65 years of age or older?

Question #02: Do you live at home alone or do you reside in an independent living community/desire living independently?

Question #03: Are you alone at home for several hours during the day or night?

Question #04: Do you require assistance with daily activities/tasks such as meal prep, bathing, dressing or making a phone call?


Question #05: Are you required to ingest two or more medications and/or prescriptions every day?

Question #06: Do you experience constant dizziness when you get in and out of a chair, sofa or bed?

Question #07: Do you suffer from a chronic ailment (i.e. falling, heart disease, diabetes, stroke, arthritis, hearing impairment)?

Question #08: Have you been hospitalized or admitted into an emergency room in the past year?

Question #09: Are you recovering from a surgical procedure and/or returning from day care/rehabilitation/physical therapy?


Question #10: In the past year have you fallen; have been anxious about falling; have recent recurring (repeated) falls?

Question #11: Do you have problems using steps, standing up, walking around furniture?

Question #12: Do you use a cane, walker and other assistive medical devices for balance and moving around?


Question #13: Are you anxious about falling when you’re alone?

Question #14: Are you anxious about falling and not being able to reach the phone to call for help?

Question #15: Are your family member caregivers worried they can’t monitor you and/or be with you 24/7 when you have a medical emergency at home alone?



If you answered “Yes” to the following questionnaire items:

URGENT NEED (Very High Risk): Questions #04; #06; #07; #09; #10.

HIGHLY RECOMMENDED NEED (High Risk): Questions #02; #08; #11; #14; #15.

RECOMMENDED NEED (At Risk): Questions #01; #03; #05; #12; #13.



URGENT NEED (Very High Risk):
Immediate/actionable emergency medical attention will be needed at home; 24/7 monitoring protection.

Emergency medical attention to your door fast; 24/7 monitoring service; push help alert button.

Maintain independent lifestyle; emergency medical attention to your door fast.


For more information or a free personal consultation, please contact our certified Medical Alert Specialist at First Response, Toll-Free at (866) 930-1130.

“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!”

Maria V. (valued client since 2009)