Free Online Screening

occupational therapist comforting older man after free screening at High Thrive Therapy in Maine

We know that the aging process can be a challenge, but sometimes we see potential issues looming that threaten to complicate health and wellness. The earlier we catch and address concerns before they become big problems, the better chance you have to maintain your health and independence.

Our free online screening tool helps us to understand you better and offers you insights that could help you get the care and attention you need early on. As always, we encourage you to share any questions and concerns with your health care provider. If your screening highlights any areas of concern for you, it may be wise to ask your health care provider for a referral for an occupational therapy evaluation and treatment at High Thrive Therapy in Portland, Maine.

Our evidence-based screening tool is used to assess early decline in many age-related developmental factors related to physical, emotional and occupational capacity.
This screening takes 10-15 minutes. Complete the entire form below and click the Submit button.
If you'd like, a caregiver or family member can complete this screen with you or for you.

Our licensed occupational therapist will assess your results and reach out to you within 24 hours. If the therapist concludes that you should be seen for a more comprehensive evaluation, they will let you know and help you to get that appointment scheduled.

Free Online Screening

High Thrive Therapy LLC

Client Information

First Name

Last Name

Date Of Birth

Primary Phone Number

City

State

Zip Code

Primary Care Information

Who is your Primary Care Physician/Healthcare Provider?

Where are they located?

Insurance Information

Primary Insurance:

Medicare Part B

Other

Insurance Name

Group Number

ID Number

Effective Date

Secondary Insurance:

Insurance Name

Group Number

ID Number

Effective Date

Occupational Self Assessment - Daily Living Scales

Completed by:

Myself

Caregiver/Family/Friend

Occupational self - Assessment Model of Human Occupation Clearinghouse, Department of Occupational Therapy University of Illinois at Chicago Daily Living Scales added by Patricia J Scott with permission from the Model of Human Occupation Clearinghouse, Department of Occupational Therapy University of Illinois at Chicago (2016) - Link

Fear of falling is a fall risk!

Fear of falling is a potential behavioral outcome of previous falls that may limit older adult activities. One in four older adults experience a fall each year, and one third of them develop a fear of falling. Fear of falling may lead to more sedentary lifestyle with subsequent deconditioning that creates an ongoing downward spiral leading to frailty and increased risk of future falls.

Fear of falling is a valid concern and your compassionate therapist will work with you to address and resolve the physical, emotional and environmental factors that contribute to the fear of falling. We'll work together to create a safer home environment and an action plan to build up your strength and balance to help you regain your confidence.

Falls Efficacy Scale - Short FES-I

Kempen GIJM, Yardley L., Haastregt JCM van, Zijlstra GAR, Beyer N, Hauer K, Todd C.

The Geriatric Depression Scale (GDS)

Choose the best answer for how you have felt over the past week:

1. Are you basically satisfied with your life?

2. Have you dropped many of your activities and interests?

3. Do you feel that your life is empty?

4. Do you often get bored?

5. Are you in good spirits most of the time?

6. Are you afraid that something bad is going to happen to you?

7. Do you feel happy most of the time?

8. Do you often feel helpless?

9. Do you prefer to stay at home, rather than going out and doing new things?

10. Do you feel you have more problems with memory than most?

11. Do you think it is wonderful to be alive now?

12. Do you feel pretty worthless the way you are now?

13. Do you feel full of energy?

14. Do you feel that your situation is hopeless?

15. Do you think that most people are better off than you are?

YES