Home Stretch Fall Prevention
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Share a little about your concerns so HomeStretch can follow up with you.

Welcome to Home Stretch Fall Prevention!

Thank you for your interest in Home Stretch Fall Prevention Training. Please complete this brief form to help us understand your needs and determine how we can best support your independence and safety at home.

Your safety is our priority. All information submitted is kept strictly confidential.

* Indicates required question.

How many times have you fallen or lost your balance in the past 12 months? *
Do you currently live alone? *
Age *
Do you feel that your body has been slowing down over the past several years? *
Are there any specific areas of your home where you feel less safe or stable? *
Would you like a representative from Home Stretch Fall Prevention to contact you to discuss a home safety assessment? *

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