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Thank you for taking the time to fill our our survey.
The Cape May County Division of Aging & Disability Services is committed to assisting senior and disabled individuals in meeting their needs.  Surveys are confidential, and results will be tallied and used for planning purposes. 

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* 1. Where do you live

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* 2. Are you a Veteran or a Spouse of a Veteran?

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* 3. Transportation to Doctors/Medical Appointments

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* 4. Addressing my own needs (bathing, dressing, etc.)

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* 5. Shopping for groceries

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* 6. Preparing your daily meals

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* 7. Cleaning your home

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* 8. Being able to pay for heat or other utilities

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* 9. Handling your own money and/or paying your bills

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* 10. Performing household chores (shoveling, mowing,
small repairs, etc.)

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* 11. Taking medications

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* 12. Completing insurance or Medicare forms

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* 13. Understanding health insurance or Medicare forms

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* 14. Providing care for another person as a caregiver

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* 15. Falling (loss of balance)

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* 16. Check which services you feel are critical needs in the community

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* 17. Age Range

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* 18. Gender

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* 19. Marital Status

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* 20. Ethnic Background 

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* 21. I Live...

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* 22. My annual income is:

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* 23. Is there any additional information you would like us to know?

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* 24. I would like to be contacted by the CMC Division of Aging and Disability Services

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* 25. Contact information

0 of 25 answered
 

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