Falls prevention checklist

Getting your falls prevention checklist

If you would like to find out how you can get help preventing falls at home, please fill in the details below so that we can send you a ‘preventing falls checklist’.

More information about preventing falls and the Fit for your future event, please see the ' Helping you prevent a fall ' page.

Data Protection Act 1998

By law we must protect your personal information (data). This means that:

we must keep the information safe
we can only use it for the reason given on the form
we can only share it with people who need to know it
we only keep it for as long as we have to, and
you have the right to see the information we are keeping about you.

Your contact details

Your first name *

Your last name *

Your address and postcode *

Your phone number

Your email address

Your falls prevention checklist

Your checklist *
Please make sure you have given us all the details we need to send your checklist to you, including if you would like it in another language or format (such as in Braille or on a CD).
By post
By email
In another language or format

Information in another language or format
If you have asked for the checklist in another language or format, please give us the details here.

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