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* 1. Which Chore Program services have you received in the past year? You can check more than one answer.

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* 2. Were you satisfied with these services?

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* 3. Do you have any problems or complaints regarding these services?

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* 4. Has the Chore Program helped you maintain your independence?

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* 5. Do you feel safer and more secure in your home?

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* 6. Would you recommend the Chore Program to others?

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* 7. How can OLHSA improve our services? What other services could we provide?

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* 8. Please provide us with any additional comments you may have.

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* 9. Contact Information

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