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Fall Risk Screening Form

Asks about fall history (Past 12 months), fall circumstances & injuries, and current medications (Count). Built for geriatric and senior care practices.

Questions
10
Page
1
Time
about 3 min

Includes

  • Medication list
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Your practice

Fall Risk Screening Form

Live preview. Tap through it like a patient.

Who it is for

  • Geriatric and senior care practices
  • Primary care annual wellness visits for 65+
  • Home health and visiting nurse services
  • Skilled nursing and rehabilitation facilities

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What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

  1. Full NameText · Required
  2. Fall History (Past 12 Months)Long Text
  3. Fall Circumstances & InjuriesLong Text
  4. Current Medications (Count)Number
  5. High-Risk MedicationsMedications
  6. Balance & Mobility ConfidenceLong Text
  7. Vision ConcernsLong Text
  8. Home Environmental HazardsLong Text
  9. Fear of FallingLong Text
  10. Assessment DateDate

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Fall Risk Screening Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 10 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Fall Risk Screening Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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