Have you fallen?

The incidence of falls is increasing in Wandsworth and because we plan the fall service, we would like your views about certain issues if you have had a fall in the last year. 

* 1. Do you know what caused you to fall?  Please describe how your fall came about and what happened next?

* 2. Have you had the following in the last 12 months?

* 3. What impact has your fall had (if any) on your daily living?

* 4. Any other comments?

* 5. If you would like us to inform you of the results of this questionnaire and / or would be interested in taking part in a focus group around falls, please leave your contact details below.