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* 1. Are you having problems performing daily living tasks, or are you concerned about becoming less capable of living independently in the next two to three years?

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* 2. Do you suffer from physical limitations due to any of the following conditions, and do you use any mobility device?  (Please select ALL that apply)

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* 3. Having problems holding a knife or cutting food? How interested would you be in having the Upright Knife grip, the GettaGripOn? (visit www.kpcaids.com)

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* 4. Can't roll dough with two hands?  How interested would you be in having a ONE-HANDED rolling pin? (visit www.kpcaids.com for details)

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* 5. Are you having issues putting on your shoes? If so, how interested would you be in having a tool to help, the ShuOn or the KatShu? (visit www.kpcaids.com for details)

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* 6. How interested would you be in a transfer board that is attached to your wheelchair and can be used easily and independently, the ZipBridge? (visit www.kpcaids.com for details)

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* 7. How interested would you be in an easy way to access a bag at the back of your wheelchair, the SakTrack?  (visit www.kpcaids.com for details)

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* 8. Problems repositioning yourself in your wheelchair or are concerned about transfers? If so, how interested would you be in a grab bar on your wheelchair, the KatzRail? (visit www.kpcaids.com for details)

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* 9. Are you concerned about falling and not being able to get up? If so, how interested would you be in an inexpensive home lift that doubles as a stepladder, the LaddaLift? (visit www.kpcaids.com for details)

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