Order Form
A future without falls – Patient Leaflet
To order the attached ‘A future without falls’ leaflet, please fill in this order form. Age
UK and the Royal College of Physicians have jointly produced this leaflet to help
older people access falls services through their GP.
The leaflet is designed for healthcare settings such as waiting rooms or for display in
libraries. We are keen for it to be placed anywhere that will catch the attention of
older people.
Please fill out your details below:
DELIVERY DETAILS
Name:
Email address:
Name of organisation:
Postal address:
Quantity:
RETURN THE ORDER FORM TO:
Claire Francis,
Stop Falling Campaign, Age UK,
Astral House,
1268 London Road,
London SW16 4ER
Alternatively, you can fax the completed form to 020 8765 7200 or send an email to
Claire.Francis@ageuk.org.uk indicating your name, the address of your organisation
and the number of copies you require.
Age UK is a charitable company limited by guarantee and registered in England (registered charity number 1128267) The registered office
address 207–221Pentonville Road, London, N1 9UZ. Age Concern England (registered charity number 261794) and Help the Aged (registered
charity number 272786), and their trading and other associated companies merged on 1 April 2009. Together they formed the Age UK group,
dedicated to improving the lives of people in later life. The three national Age Concerns in Scotland, Northern Ireland and Wales have also merged
with Help the Aged in these nations to form three registered charities: Age Scotland, Age NI, Age Cymru.