Fall Prevention Program
Tell us a bit about yourself so we can match you with professionals who can help you avoid falls.
There are 3 ways to get help preventing falls:
Monday – Friday, 9:00 a.m. to 5:00 p.m. (mountain time)
or Fill out the form below
to have a referral specialist contact you.
or Request via a Printed form
Print and fill out a form manually – then mail or fax it back.A. Printable Request Form
(print then fill in manually) B. Printable Interactive PDF Version
(complete electronically then print)