Home Safety Modification Referral Form

If you are a senior (60 years or older) in Contra Costa County or an Unpaid Caregiver to a senior, you can request a home safety assessment.  This service is subject to funding availability and eligibility requirements.  

Please view and print our Fall Prevention Home Safety Modification Referral Form, fill out, and fax to 925.946.1869 for us to determine your eligibility for this service.   Alternately, call 925.937.8311 or email Fall Prevention Program Manager Alayne Balke at abalke@mowdr.org