Senior Services Survey

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* 1. Your Age (optional)

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* 2. What is your gender?

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* 3. Your closest town

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* 4. Have you, a family member or friend used the services of Area IV?

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* 5. How would you rate the quality of Area IV services?

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* 6. Do you know what the Ombudsman Program is?

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* 7. What are the most pressing needs of seniors in your community that are not being met adequately? Please mark the TOP THREE NEEDS in your community, or write in a need(s) not currently being met under "Other".

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* 8. Are there new services that will be needed to meet the aging boomer population?

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* 9. If you answered "yes" to number eight, please specify needs to meet the aging boomer population. If you answered "no" to number eight, please enter "no" again. 

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* 10. If you wish, please provide any other thoughts on the performance of Area IV Agency on Aging and services provided or not provided.

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