30%
Questions marked with an * are required Exit Survey
 
 
Name
 
 
 
 
Email Address *
 
 
 
 
Best Phone Number(s) *
 
 
 
 
Gender *
 
 
 
Age *
 
 
 
 
What best describes your ethnic background? *
 
 
 
Which of the following describes your employment status?
 
 
 
What percentage of the HOUSEHOLD SHOPPING would you say that you, personally, do for your household? This includes household products as well as food items.
 
 
 
Are you a caregiver for any adult age 55 or older who is struggling with aging or has a medical condition?
(By caregiver, we mean that you take care of someone who is unable to complete some daily tasks on their own. This care may include one or more activities such as managing medications, talking to doctors and nurses on someone’s behalf, helping to bathe or dress, taking care of household chores, meals or bills for someone who cannot do these things alone.)
 
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