Personal Information

The purpose of the following survey is to gather information from community members within our service area in order to help your local health department, and your region’s Area Agency on Aging to more effectively, and efficiently, provide the aging population with the health-related services that they need.

Please take some time to fill out the survey. Your input is very valuable and we appreciate your participation in this assessment.

If you need help with completing this survey, or have any questions related to it, please contact:

Cami Emerson, Community Health Specialist
Region 2 Area Agency on Aging
(517) 592-1686

Thank You!

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* 1. What county do you currently reside in?

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* 2. How many individuals live at your residence?

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* 3. How many members of your household are 60+ years of age?

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* 4. Do You Have Any Mobility Issues That Require Assistance (i.e. trouble walking on your own or unable to drive on your own)? Select One.

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* 5. Do you help a friend/family member complete daily care, get to doctor's appointments, go shopping, etc.?

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