1. Have you fallen in the past 12 months?(Required)

2. Do you feel unsteady when walking or turning?(Required)

3. Do you need to hold onto furniture or walls when moving at home?(Required)

4. Do you avoid activities because you’re afraid of falling?(Required)

5. Do you feel stiff or unsteady when first standing up after sitting or lying down?(Required)

6. Do you have trouble walking on uneven surfaces like sidewalks, grass, or stairs?(Required)