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Strictly no falling logo

Referral Form

The Strictly No Falling Referral form is below.

This can be used for new referrals to falls classes (section 1 and 2) or instructors can provide individual assessment scores (sections 1 and 3).

Phone or post

If you have any difficulties then you can call 01773 766922 or post to Age UK Derby and Derbyshire, 29a Market Place, Heanor, DE75 7EG

Statements for GDPR

padlock symbolWe need to ask you for information about you (your data) in order to note your permission to record and store your data. The information is only what we need in order to deliver your service.

The details entered on the form below are captured securely by Dizions and then automatically entered into our secure system called Charitylog.

We will keep your information securely and delete the information as soon as we can. We will ask your premission before passing information to another organisation.

If you are entering the information on behalf of someone else, they need to have agreed to these statements before you enter their personal information.

Falls Referral Process

We have put together a guide to explain what will happen after you submit a referral.

Exercises at home

To help you keep active at home, our SNF team have put together a series of short videos with simple exercises to help improve your mobility, cardiovascular fitness, balance, strength and flexibility.

Useful documents to download

The document below gives loads of tips and advice on how to stay independent and things you can do to prevent falls. Includes exercises and how to get up correctly if you do fall.