1. What’s your relationship to the person you’re concerned about?

2. Where are you currently based?

Takes under 3 minutes · No login required · Your answers are private

3. How old is your parent or loved one?

4. Who is with them on a daily basis?

5. If your parent had a medical emergency right now, is there someone within 15 minutes who could take charge?

6. Has your parent had a fall or a near-miss in the last 12 months?

7. Are their medications currently being reviewed by a doctor at least every 6 months?

8. How often does your parent leave the house or have a meaningful conversation with someone outside the home?

9. Is your parent managing daily tasks like bathing, cooking, and getting around without difficulty?

Tell us the one worry that brought you here - and where to send your TCRI report.

10. If you could resolve one concern today, which would it be? (Optional)

11. Is this an urgent situation right now?

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Last Name

Phone *

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Click submit to get the report.