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Hello:
You are invited to participate in our survey for adults who are 50+. We would like customer feedback so that we can develop a plan that will cater do your specific needs. Our focus is to offer Personal Care, Housekeeping, Delivery of cooked Meals, Transportation, Social Engagements, Recretional Programs, and Health/Wellness Programs. In this survey, approximately 100 people will be asked to complete a survey that asks questions about our product line, our services and your requirments. It will take approximately 5 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 us 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 [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
Contact Information
First Name : 
Last Name : 
Phone : 
Email Address : 
 
 
 
Check the box that you would be interested in.
 
Housekeeping
 
Personal Care
 
Companionship
 
Programs/Educational/Creative Workshops
 
Programs/Recreational
 
Health and Wellness/Yoga, Dietician, Nutrionist , Fitness, Massage
 
Meals/Delivery
 
Transportation
 
Running Errands
 
Spa Treatments

 
 
 
* Specify a service that you would be interested in.
   
 
 
 
Very Satisfied
 
 
 
 
Name
   
What is your Ethnic background?