Onboarding Survey

Before we begin we will need to learn a little more about you and your aging loved one. Please complete this survey, it should only take a few minutes!

Click the button below to start.

Start

Question 1 of 11

Email Address

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Question 2 of 11

Which State do you live in?

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Question 3 of 11

What's your name?

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Question 4 of 11

What is your current relationship status to the loved one you are helping?

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Question 5 of 11

Do you have more than one loved one you are helping?

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Question 6 of 11

What do you hope to gain?

(Select all that apply)

A

General Support and Troubleshooting Challenges

B

Care Related Concerns

C

Improving Communication

D

Understanding Senior Care Options

E

Financial Related Concerns

F

Community Support

G

Dementia/Memory Care Support

H

Caregiving Support

I

Other

Question 7 of 11

Where does your aging loved one reside?

A

With Family

B

At a Senior Living Community

C

Long Term Care

D

At Home

Question 8 of 11

What is your cellphone number?

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Question 9 of 11

When are you typically available?

A

Mornings

B

Afternoons

C

Evenings

Question 10 of 11

Is there anyone already in your family you would like to share information with?

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Question 11 of 11

We're curious to hear how you learned about us?

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Confirm and Submit

Name

Email

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