PLAN Family Check-in Question Title * 1. Can you please tell us your name and email? First & Last Name Email Address OK Question Title * 2. What is your biggest concern/fear during the COVID-19 crisis? OK Question Title * 3. Has someone connected with you in a meaningful way today? This week? Yes No If Yes, can you tell us about it? OK Question Title * 4. Have you reached out and connected with someone you consider at risk of being isolated recently? Yes No If Yes, can you tell us about it? OK Question Title * 5. Is there anything we can do to support you to feel more connected? (phone you regularly, set up a video chat, reach out to someone you know to suggest you stay connected) Yes No If Yes, what can we do to support you to feel more connected? OK Question Title * 6. Have you done something to support others? (shopped for groceries or other necessities, picked up medication or run an errand for someone?) Yes No If Yes, can you share your story? OK Question Title * 7. Is there anything we can do to support you? (shop for groceries or other necessities, pick up medication, run an errand) Yes No If Yes, what can we do to support you? OK DONE
