History of fall in the past year?

Yes

No

Vertigo and/or dizziness?

Yes

No

Poor balance?

Yes

No

Fear/anxiety of falling?

Yes

No

Difficulty walking?

Yes

No

Use of assistive devices such as a cane to walk?

Yes

No

Orthopedic concerns, including arthritis or total joint replacement?

Yes

No

Blood Pressure and/or Cardiovascular problems?

Yes

No

Vision impairment?

Yes

No

Vitamin D insufficiency?

Yes

No

Muscle weakness?

Yes

No

History of Stroke or Neurological disease (example: Parkinson's, Multiple Sclerosis)?

Yes

No

If you have answered “yes” to one or more of the above conditions, we recommend that you discuss your situation with your primary care provider.

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