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  1. Surveys
  2. 2017
  3. January
  4. S
  5. Seniors and Disabled Lives Matter
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Exit Survey
 
 
Hello:
You are invited to participate in our survey "Seniors And Disabled Lives Matter". In this survey, approximately 500 people will be asked to complete a survey that asks questions about what you believe seniors and disabled persons are entitled to from the local businesses they patronize regularly . It will take approximately 3 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for me to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Janet Smith at 208-8917669 or by email at [email protected]..

This survey will be sent to local businesses in your area to promote positive changes in their services to seniors and the disabled not covered by the governments disability act.  Thank you for your time and opinions.  Please start the survey now by clicking the "NEXT" button below.
 
 
 
 
Are you a senior or disabled person?
Please select only one answer.
 
 
Yes
 
No
 
 
 
Do you believe that seniors and/or the disabled should receive special privledges and/or services from the local businesses that they patronize?
Please choose only one answer.  
If answering "No", thank you for your opinion.  
You may exit, your portion of the survey is completed.
 
 
Yes
 
No
 
 
 
Do you believe that seniors and/or the disabled should have free delivery of their grocery order on a weekly basis with a reasonable minimum order requirement set by the grocery?
Please select only one answer.
 
Yes
 
No
 
 
 
Do you believe that seniors/and or the disabled should have free public transit rights? (Bus,Rail,Metro)
Please select only one answer
 
Yes
 
No
 
 
 
Do you believe that seniors and/or the disabled should be permitted to have their spouse help them in the dressing room even if it is designed for just women or men?
Please select only one answer.
 
Yes
 
No
 
 
 
Do you believe that seniors and/or the disabled should receive free personal shopping assistance?
Please select only one answer.
 
Yes
 
No
 
 
 
Please take a moment to add any comments and/or suggestions.
   
 
 
Contact Information: NOT required.  

If supplied, it will be used to send you the survey and subsequent results only.  

No informtion will be sold or dispersed in any manner.  
First Name : 
Last Name : 
Phone : 
Email Address : 
 
Thank you so very much for taking the time to complete the survey.  I am hopeful that the results will initiate some positive changes.  Please feel free to contact me at any time.