Pre-Screening Questionnaire – DIGITAL FORM
Electronically Delivered eForm* - Available Now – Subscribe Today!
Briggs Digital forms:
-Updates included with annual subscription
-Form-fillable PDF documents at your fingertips
-Easy to complete on any device
UPDATED 2022
Use Briggs Pre-Screening Questionnaire is used to learn more about the needs and services to meet those needs of a prospective Assisted Living resident, including:
| • | Current and prior living situation |
| • | Bathing, Dressing, Oral Care, Hair Care |
| • | Ambulation |
| • | Prosthesis |
| • | Waking Up/Getting Out of Bed, Sleeping |
| • | Preparing for Bed/Getting Into Bed |
| • | Need for Daytime and/or Nighttime Monitoring |
| • | Toileting |
| • | Special Diet Needs |
| • | Dining/Eating |
| • | Medications - OTC, Prescription, Injections |
| • | Assistance Needed with Personal Affairs/Appointments/Transportation |
| • | Social/Activities |
| • | Housekeeping |
| • | And other important Physical/Social Considerations |
Download a sample today!
License Agreement
Send completed License Agreements toCustomerSupport@BriggsCorp.com
*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.
Delivery: Digital*
Digital/electronic merchandise & subscriptions: all digital and electronic products and subscriptions are non-refundable and non-returnable.
*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.