Hertfordshire Active Living
This form enables health professionals working with you to find out how you are managing at home, and whether you need any extra help to reduce your risk of falling and getting hurt in future.
Anyone who is aged over 75, can fill in this form. A carer, family member or a health professional - such as a doctor or nurse - can fill in the form with you if you need help.
If the answers you give show that you are at a higher risk of falling, the people involved in your care will be able to signpost you to further advice and support.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key known only to the GP practice and is
accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.