Healthcare & Clinical · community shared

Fall Risk Assessment Form — shared by the community

Dev A. shared this 16-question build with 1 conditional rule already wired up. Test it below, then take a copy.

A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 16 questions, 3 pages, 1 conditional rules.

Shared by
Dev A. · Freelance consultant
Questions
16
Replies
14
Copies taken
171
See the library version

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Live preview and test console

This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.

Page 1 of 3 — About the patient

Fall risk assessment

Has the patient fallen in the past 12 months?

1 question is hidden by conditional logic right now — change an answer above to reveal it.

Works for you? Take Dev A.'s copy into your own workspace — questions, rules and settings included.

Who this template is for

Fall Risk Assessment Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

  • Small teams who need a reliable intake process working in healthcare & clinical.
  • Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
  • Anyone replacing chasing missing details over email with one structured record per enquiry.
  • Respondents are the people you send it to — the form asks them 16 questions across 3 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

  • 12 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It records a signature you can keep as proof of agreement.
  • It pins the request to a specific date.
  • It allows multiple selections without free text.
  • Conditional logic hides 1 question until they are relevant — shorter forms convert better than long ones.
  • Splitting the form across 3 pages keeps each screen short and shows respondents how much is left.
  • Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Fall Risk Assessment Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 1 conditional rule ship with it.

  • Features advanced show logic: if “Has the patient fallen in the past 12 months?” is Yes, the form dynamically exposes “Describe the most recent fall, including where and how it happened”. Otherwise that question never appears.
  • All 1 rule are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

What this form asks

Page 1 — About the patient

  • Patient full namerequired
  • Date of birthrequired
  • Assessed byrequired
  • Has the patient fallen in the past 12 months?required
  • Describe the most recent fall, including where and how it happened

Page 2 — Mobility and health factors

  • Walking aid usedrequired
  • Any difficulty with balance or walking?required
  • Vision problems affecting mobility?required
  • Current medications
  • Reports dizziness or lightheadedness?required

Page 3 — Environment and plan

  • Home environment hazards noted (stairs, rugs, lighting, clutter)
  • Does the patient live alone?required
  • Fall prevention measures already in place
  • Recommended next steps or referralsrequired
  • Assessor signaturerequired
  • Date signedrequired

Conditional logic in this build

  • When “Has the patient fallen in the past 12 months?” is Yes, show “Describe the most recent fall, including where and how it happened”.

Questions about this shared form

Does this form produce a risk score?

No. It records the history, factors and observations an assessor gathered; scoring or grading them is left to your clinical process, not this form.

Can it be used in a clinic instead of at home?

Yes, though the environment section works best completed during an actual home visit, since a description given secondhand is less reliable.

Who should complete the environment section?

Whoever conducts the home visit, ideally after walking through the areas the patient uses most, rather than relying only on what the patient reports.

How often should this be repeated?

That depends on your program's policy and the patient's condition; set the review date on the form itself so it does not get missed.

Is the Fall Risk Assessment Form template free to use?

Yes. You can preview and test Fall Risk Assessment Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Fall Risk Assessment Form template ask for?

It asks 16 questions across 3 pages, 12 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Fall Risk Assessment Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this healthcare & clinical form work?

1 conditional rule ships with the template: Features advanced show logic: if “Has the patient fallen in the past 12 months?” is Yes, the form dynamically exposes “Describe the most recent fall, including where and how it happened”. Otherwise that question never appears. All 1 rule are editable in the Logic tab, and the built-in checker warns about rules that contradict each other. All rules are editable in the Logic tab.

Where do responses to the Fall Risk Assessment Form form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Fall Risk Assessment Form form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Is the signature on this form legally usable?

The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.

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