Take Our Home Safety Quiz

Take Our Home Safety Quiz

Fill this short form out to assess your Home Safety needs:

Who is completing this Quiz? *

I am taking this quiz for myself

I am taking this quiz for someone else

First Name *

Last Name *

Phone *

Email *

Are your walkways, hallways, and stairs clear of clutter? *

Yes

Sometimes

Do you have secure handrails on both sides of any stairs? *

Yes

Not Applicable

Is your bathroom equipped with grab bars or non-slip surfaces? *

Yes

Do you ever feel unsafe carrying laundry, groceries, or other items? *

Yes

Sometimes

Can you safely get in and out of bed without assistance? *

Yes

Sometimes

Is your home lighting bright enough for you to see clearly at night? *

Yes

Sometimes

Do you have cords, rugs, or uneven flooring that could cause tripping? *

Yes

Is your kitchen set up so frequently used items are easy to reach? *

Yes

Sometimes

Do you feel confident leaving your home in case of an emergency? *

Yes

Sometimes

Has your doctor or family expressed concerns about your safety at home? *

Yes

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

DRM Wellness

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