What is you age group?

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* 1. What is you age group?

Please identify your preferred FOOD SHOPPING DESTINATION

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* 2. Please identify your preferred FOOD SHOPPING DESTINATION

Please identify the Hospital/Outpatient Care facility your primary care physician is affiliated with.

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* 3. Please identify the Hospital/Outpatient Care facility your primary care physician is affiliated with.

Please identify your preferred Pharmacy

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* 4. Please identify your preferred Pharmacy

Please identify your preferred RETAIL SHOPPING destinations.

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* 5. Please identify your preferred RETAIL SHOPPING destinations.

Please identify your preferred Restaurants.

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* 6. Please identify your preferred Restaurants.

Would you use CART shuttle for employment purposes?

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* 7. Would you use CART shuttle for employment purposes?

Do you attend regular community provided services (ie Meals on Wheels, Workshops, Educational Activities, Senior Center)

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* 8. Do you attend regular community provided services (ie Meals on Wheels, Workshops, Educational Activities, Senior Center)

What days do you typically attend Town of Derry located or provided services (ie Meals Programs, Workshops, Educational)

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* 9. What days do you typically attend Town of Derry located or provided services (ie Meals Programs, Workshops, Educational)

What hours do you typically attend the above programs?

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* 10. What hours do you typically attend the above programs?

Would you like to have a regular connection to the Manchester / Boston Regional Airport?

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* 11. Would you like to have a regular connection to the Manchester / Boston Regional Airport?

Would you like to have a regular connection to the Mall of New Hampshire?

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* 12. Would you like to have a regular connection to the Mall of New Hampshire?

Would you like to have a regular connection to Boston Express Bus Service?

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* 13. Would you like to have a regular connection to Boston Express Bus Service?

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