Introduction and Consent

The Warren County Senior Services Task Force is a multi-disciplinary group of agency representatives seeking to assess, develop, and implement programs and program changes geared toward assisting senior citizens and their families in Warren County. In order to more accurately understand the needs of Warren County seniors, their families, and their caregivers, we have created a brief survey that seeks to provide the task force with a better understanding of the priorities that you believe need to be addressed to improve the quality of life for Warren County seniors. The data gathered through this survey will allow for various Warren County agencies to tailor their efforts to address the most pressing issues affecting seniors. These efforts will take the form of bridging gaps in services and also finding areas where services are already being delivered and fortifying current efforts.

Your participation in this research study is voluntary. You may choose not to participate. If you decide to participate in this research survey, you may withdraw at any time. If you decide not to participate in this study or if you withdraw from participating at any time, you will not be penalized.

The procedure involves filling an online survey that will take approximately 5 minutes. Your responses will be confidential and we do not collect identifying information such as your name, email address or IP address. The survey questions will be about your opinion on services provided to senior citizens in Warren County.

We will do our best to keep your information confidential. All data is stored in a password protected electronic format. To help protect your confidentiality, the surveys will not contain information that will personally identify you. The results of this study will be used for scholarly purposes only and may be shared with Warren County Senior Services Task Force representatives.

If you have questions regarding the Senior Services Task Force please contact Chris Balster at cbalster@wcchd.com or 513-695-1728.

* 1. ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "agree" button below indicates that:

• You have ready the above information
• You voluntarily agree to participate
• You are at least 18 years of age

If you do not wish to participate in the research study, please decline participation by clicking on the "disagree" button.

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