Home Assessment Pre Visit Questionnaire

Sent to the client before an in-home safety and wellbeing visit takes place. It covers general health, recent falls, medication, exercise habits and everyday difficulties, then moves on to the layout of the house, including stairs, bathrooms and grab bars. The assessor arrives already prepared.

Use this template

In the Claude connectors directory

Page 1

First Name
Last Name
Street Address
City
State / Province
ZIP / Postal Code
Not likely
Very likely

Page 2

Page 3

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