Advanced Senior Support

Locally owned & operated near Central College

Home Health & Mobile Therapy

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In-Home Safety Assessment

Creating a safe home starts with understanding the unique needs of the person you love. Our in‑home safety assessment is designed to offer gentle guidance, practical recommendations, and a clearer picture of how to support comfort and independence. Share a few details below, and we’ll help you take the next step toward a safer, more confident living environment.

Safety Assessment Request

First name*

Last name*

Email address*

Phone number*

Preferred Contact Method*

Call

Text

Preferred Assessment Type*

In-home Visit

Phone Consultation

Who Is This Assessment For?*

Myself

Spouse

Parent/Grandparent

Other

Scheduling Preferences*

Morning

Afternoon

Evening

Flexible/No preference

Address where the assessment will take place if an in-home visit is preferred:

Type of Home

House

Apartment

Assisted/Independent Living

Senior Community

Other

Main Concerns*

Fall Risk

Bathroom and/or Kitchen Safety

Mobility Changes

Dementia-related safety

Medication Organization

Emergency preparedness

General Home Safety

Not sure - I'd like guidance

Other

Is there anything else you would like us to know - or any information that could be helpful before we visit? (Please include details of any recent falls, close calls, or safety hazards if applicable)

I understand this assessment is informational and designed to support home safety, but it does not guarantee the prevention of accidents or injuries.

Thank you for trusting us with this part of your journey. Once we receive your form, a member of our team will reach out to schedule your assessment and answer any questions you may have. We’re here to make this process simple, supportive, and centered around your loved one’s well‑being.

Advanced Senior Support

Home Health & Mobile Therapy

Providing skilled, compassionate home health care for Central Ohio

Contact Us

Phone: 614-891-7480

Quick Links

We work with and are certified by Medicare

We work and partner with Ohio Association of the Deaf INC

Fax: 614-891-7430

Care With a Heart - Non-Medical Home Care

Location

HIPAA Notice of Privacy Practices

855 South Sunbury Road
Westerville, OH 43081

Terms & Conditions

Accessibility Statement

Advanced Senior Support does not discriminate based on race, color, national origin, age, disability, sex, gender identity, sexual orientation, religion, or any other protected characteristic. We provide equal access to services for all patients.