ElderCARE Loneliness Quiz

For persons living North of Highway 60 to the State line.

*There are no right or wrong answers.

*We would like for you to be completely honest.

*Please think of your life as it generally is now.

Question Title

* 1. How often do you feel that you lack companionship?

Hardly ever

Some of the time

Often

Question Title

* 2. How often do you feel left out?

Hardly ever

Some of the time

Often

Question Title

* 3. How often do you feel isolated from others?

Hardly ever

Some of the time

Often

Question Title

* 4. Would you like a friendly visitor volunteer from ElderCARE?

Yes

Question Title

* 5. Contact Information

Name

Phone Number

ElderCARE provides free medical transportation, shopping, and friendly visits.

Find out more about ElderCARE services by calling 847-406-4683.

Thank you for filling out the quiz!