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

* 2. Were you satisfied with these services?

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

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

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

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

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

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

* 9. Contact Information