Falls Clinic Self Referral Screening Questions

• Are you aged 65 years or older?
• Are you registered with a Sutton GP?
• Are you able to attend Cheam Priory Day Centre Clinic?
• Have you had 2 or more falls in the past 12 months or feel unsteady on your feet?
• Are you mobile with or without a walking aid
• Are you medically stable and uninjured?

If yes to all then proceed to the next question, otherwise, please contact your GP in the first instance if you require clinical support or guidance.

MIS Self referral form