Thank you for participating in Take Care Together.

Privacy

Your name and information will not be shared with any organization, business or individual outside of SAGE Upstate.

Why
  • Completing this survey enrolls you in the Take Care Together program.
  • It's a starting point -- it gives us information on you before taking part in the program.

How
  • You do not have to answer every question, but we do need your name and contact info.
  • Some of the questions are personal in nature. Please answer as honestly as you are able. This information will not be used for anything other than this program.
  • If you'd rather fill out a hard copy of this survey, contact Leslie at 315-478-1923 or llamb@sageupstate.org and we will provide one.

What will SAGE do with the information?
  • It will be used to structure sessions based on your interests and concerns.
  • We will compare it with a survey we will ask you to take at the end of this program.
  • Our findings will be shared at the closing event in September and used in developing future programs.

Thank you again for your participation.




Question Title

* 1. Please provide us with your name.

Question Title

* 2. Please provide your contact information -- email address, phone number, address or all three.

Question Title

* 3. What is your age?

Question Title

* 4. Please provide the county where you live.

T