Get Help - Covid-19 Support Question Title * 1. I consent for the United Way North East Ontario to share my contact information as provided with area supports to respond to the needs I am identifying below Yes Question Title * 2. I require assistance with the following (check all that apply) I would like help with grocery shopping, pick-up and/or delivery I would like someone to help me understand how to use technology (how to use my cellphone or tablet, zoom or other web conferencing applications, etc.) I would like someone to talk to/social support Other (please specify) Question Title * 3. Please select your current age range 39 or under 40 to 54 55 to 64 65 to 79 80 + Question Title * 4. Do you have any mobility issues? Yes No Question Title * 5. Do you have any of the following health symptoms? Please check all that apply Fever (greater or equal to 38°C) Cough Difficulty breathing Question Title * 6. My contact information Name Address Address 2 City/Town Province Postal Code Country Email Address Phone Number Question Title * 7. The best way for someone to reach me Phone Email Question Title * 8. Please share anything else we should know about your current situation Done
