- by On Site for Seniors 2021

We appreciate your best responses to this survey. Your health data is protected by HIPAA and will be used to improve patient experiences with our telehealth, respite care, and other health services.

If you have any questions, please contact a nearby On Site for Seniors Staff Member or phone Monica at 208-967-4771. 

We appreciate your best responses to the following questions. The estimated time to complete this is only 3 to 5 minutes for 10 Questions. Thank you so much!

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* 1. Have YOU, or the Loved One you are caring for, seen your Primary Care Provider (or General Practitioner) in the past 12 months?

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* 2. Specialists are doctors like surgeons, heart doctors, psychologists, pain specialists, foot doctors, eye doctors, and other doctors who specialize in one area of health care.

In the last 12 months, how difficult was it to get appointments with Specialists?

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* 3. Have you ever seen a healthcare provider over a secure Telehealth video call?

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* 4. How satisfied have you been with your Telehealth video call?

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* 5. At times, Seniors and their Caregivers can become very stressed from family dynamics, changing emotions, and disappointments of life circumstances.

A few hours separated from this responsibility can enhance the quality of life for everyone. This is "RESPITE CARE."

Is there a need for a Caregiver and Loved One to have "Respite Care" in your family or household?

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* 6. How many times in the average week do you engage in 30 MINUTES or more of LIGHT ACTIVITY (for example, leisurely walking, shopping, light housework?)

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* 7. How many times in the average week do you engage 30 MINUTES of MODERATE ACTIVITY (brisk walking, yard work, gardening, light bicycling)?

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* 8. In what zip code is your home? (enter 5 digit zip codes, for example, 83815, 83864)

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* 9. What is your age, or the age of your Loved One?

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* 10. Optional: If you would like to participate in future surveys, research studies, or receive other health care announcements, or news, please enter your email below:

0 of 10 answered
 

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