Survey on Senior Issues // DOROT

Survey on Senior Issues

Your opinion counts!
Please help us by answering the questions below.

(* = required)

Please enter your information.

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Name:

First Required	Last Required

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Email: Required

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* 1. What do you think is the biggest concern facing seniors in your community? Please rank the following from 1 to 4 by placing a number in each box, with 1 equaling highest priority.

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Question - Required - Isolation and loneliness

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Question - Required - Food/Nutrition

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Question - Required - Availability of wellness programs (physical and mental stimulation)

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Question - Required - Transportation

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Question - Required - 2. What is your age? Under 35
35-49
50-64
65-74
75+

Question - Not Required - Comments:

Results will be posted on our website. If you provided comments, they may be published along with your first name and last initial.