The purpose of this survey

Community Action Dacorum intend to launch, in the early Autumn, a new Door to Store service in the Hemel Hempstead area to support elderly and disabled people access their local supermarket.
Door to Store is not only a means to purchase shopping but the social and well-being needs of residents are at the heart of its design enabling individuals to remain independent and socialise and meet other people. The friendly supportive service will also provide information and advice on healthy eating, suggested recipes for cooking for one and an opportunity to recycle any unwanted products at the supermarket recycling centre.
To set up Door to Store in your community we need to understand in more detail the type of service you want. This service is for the community so please help us to design the right service for you!

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* 1. Please tell us how you currently do your supermarket shopping (tick any that apply):

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* 2. Would you use a paid for Shopping Service?

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* 3. Please tell us which supermarket you would like to go to:

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* 4. Please tell us how frequently on average you would use the service:

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* 5. Please tell us what day of the week would suit you best

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* 6. Please tell us what time of the day you would like the service to operate

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* 7. Would you be prepared to pay £4 for the return journey service?

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* 8. Would you need an escort to help you get on/off a minibus and/or help with your trolley in the supermarket?

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* 9. Would you be interested in receiving advice on healthy eating?

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* 10. Would you be interested in receiving recipe information on cooking for one?

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* 11. Would you like to use the service to help you recycle using supermarket facilities?

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* 12. And finally, a little bit about you.

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* 13. Your location

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* 14. Age group: (tick any that apply)

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* 15. How many people in your household

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* 16. Does any long standing illness, disability or infirmity affect your ability to travel?

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* 17. Name and address

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* 18. e-mail address

Thank you for your time in completing this questionnaire it is very much appreciated

For more information please contact Deborah Fogden to Community Wheels, 48 High Street, Hemel Hempstead Herts, HP1 3AF, Tel: 01442 253935 - Fax: 01442 239775 - www.communityactiondacorum.org.uk, Registered Charity No. 288080
deborah@communityactiondacorum.org.uk

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