AdvantAge 50 Survey

Question Title

* 3. Age

50-55

56-60

61-65

66-70

71-75

76-80

81-85

86+

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* 4. Is your primary care provider a Sarah Bush Lincoln doctor or mid-level provider?

Yes

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* 5. Do you use other Sarah Bush Lincoln services (i.e. surgery, orthopedics, cardiology, ENT, etc)

Yes

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* 6. If you answered Yes to question #5, please list which services.

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* 7. Based on your participation in the last five years, please check the boxes next to the service you have used. Select all that apply.

Basement Bistro (SBL Cafeteria) discount

Gift Shop discount

Dial-A-Ride discount

Lifeline discount

AdvantAge50 preferential parking

Bus trips

Classes

Question Title

* 8. How did you first hear about AdvantAge 50?

Dial-A-Ride

SBL Registration (for a test/procedure)

Basement Bistro

Brochure rack in the Health Center

Newspaper

Social Media

Sarah Bush Lincoln website

Other (please specify)

	No interest	Mild interest	Medium interest	High interest
Cooking classes featuring unusual foods or new techniques	Cooking classes featuring unusual foods or new techniques No interest	Cooking classes featuring unusual foods or new techniques Mild interest	Cooking classes featuring unusual foods or new techniques Medium interest	Cooking classes featuring unusual foods or new techniques High interest
Exercise Programs	Exercise Programs No interest	Exercise Programs Mild interest	Exercise Programs Medium interest	Exercise Programs High interest
Craft	Craft No interest	Craft Mild interest	Craft Medium interest	Craft High interest
Computer Classes (How to use the new Word program)	Computer Classes (How to use the new Word program) No interest	Computer Classes (How to use the new Word program) Mild interest	Computer Classes (How to use the new Word program) Medium interest	Computer Classes (How to use the new Word program) High interest
Social Media Classes (How to use Facebook, Pinterest, Instagram, etc)	Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) No interest	Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) Mild interest	Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) Medium interest	Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) High interest
Patient Portal classes	Patient Portal classes No interest	Patient Portal classes Mild interest	Patient Portal classes Medium interest	Patient Portal classes High interest
Cell phone classes (How to use your cell phone)	Cell phone classes (How to use your cell phone) No interest	Cell phone classes (How to use your cell phone) Mild interest	Cell phone classes (How to use your cell phone) Medium interest	Cell phone classes (How to use your cell phone) High interest
Card Club	Card Club No interest	Card Club Mild interest	Card Club Medium interest	Card Club High interest

No interest

Mild interest

Medium interest

High interest

Cooking classes featuring unusual foods or new techniques

Cooking classes featuring unusual foods or new techniques No interest

Cooking classes featuring unusual foods or new techniques Mild interest

Cooking classes featuring unusual foods or new techniques Medium interest

Cooking classes featuring unusual foods or new techniques High interest

Exercise Programs

Exercise Programs No interest

Exercise Programs Mild interest

Exercise Programs Medium interest

Exercise Programs High interest

Craft

Craft No interest

Craft Mild interest

Craft Medium interest

Craft High interest

Computer Classes (How to use the new Word program)

Computer Classes (How to use the new Word program) No interest

Computer Classes (How to use the new Word program) Mild interest

Computer Classes (How to use the new Word program) Medium interest

Computer Classes (How to use the new Word program) High interest

Social Media Classes (How to use Facebook, Pinterest, Instagram, etc)

Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) No interest

Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) Mild interest

Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) Medium interest

Social Media Classes (How to use Facebook, Pinterest, Instagram, etc) High interest

Patient Portal classes

Patient Portal classes No interest

Patient Portal classes Mild interest

Patient Portal classes Medium interest

Patient Portal classes High interest

Cell phone classes (How to use your cell phone)

Cell phone classes (How to use your cell phone) No interest

Cell phone classes (How to use your cell phone) Mild interest

Cell phone classes (How to use your cell phone) Medium interest

Cell phone classes (How to use your cell phone) High interest

Card Club

Card Club No interest

Card Club Mild interest

Card Club Medium interest

Card Club High interest

AdvantAge 50 Survey

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* 1. Demographics

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* 2. Your city

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* 3. Age

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* 4. Is your primary care provider a Sarah Bush Lincoln doctor or mid-level provider?

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* 5. Do you use other Sarah Bush Lincoln services (i.e. surgery, orthopedics, cardiology, ENT, etc)

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* 6. If you answered Yes to question #5, please list which services.

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* 7. Based on your participation in the last five years, please check the boxes next to the service you have used. Select all that apply.

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* 8. How did you first hear about AdvantAge 50?

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* 9. Please rate your interest in each of the potential future class offerings: