Feedback

 

 

Thanks!

 

And, thank you for taking the time to complete this form.  Your comments are very important to us and help us continue to improve the information that we provide for you.  We'd love to hear from you!

I only have a nano second! We know your time is short and valuable. For most of what we ask, you are able to just click an option.

 

This information will not be shared unless you tell us we may use it. Even then, we will only use your comments about the site and - if you allow - your name and state. All the other information will be used only to help us decide if we are providing you with what you need, how best to present it, and how to reach other caregivers. Thank you for your assistance.

You may also send an email if you prefer. However, we would really appreciate as much detail about your situation as you would care to share. It helps us to know what to research and put online for you. Please note that requests for assistance should be addressed to your caregiver specialist. We are not able to answer emails that request assistance. Please let us know if we may use your name and information you provide.

Contact Us By Email


Tell Us About You and What You Think!

How did you find out about the site: (choose one)

Bing
blog
business card for the site
chatroom
conference
co-worker
doctor or healthcare provider
flyer
for-profit website
friend
Facebook
Google
government website
local agency such as a Council on Aging
message board
newspaper
non-profit website
radio
search engine other than Google or Yahoo
TV
Yahoo
Other

 

What information did you find the most useful?
(choose as many as is appropriate)

Assisted Living Information
Alzheimer's
Caregiver Issues - General
Checklists
Contact Information for Local Help
Difficult Discussions
Disaster Preparedness
Distance Caregiving
Driving
End of Life Information
Finding Services
Grandparents Caring for Grandkids
Health and Wellness
How to Use the Site
I Need Help Fast
Legal Issues
Nationwide States Pages
North Carolina Section
Nursing Home Care
Paying for Care
Prescription Drugs
Remaining Independent
Safety
Stress
Understanding What Services are Available
Veteran's Resources

Please use the comments section below to add additional information.

 

Approximately how many times have you visited?

This is my first time
1-5 Times
5-10 Times
More than 10 times

 

Do you plan to visit again?

Yes
No

 

Did you find what you were looking for?

Yes
No

 

If you answered no, please let us know what you were looking for.

 

If you answered no, would you like someone to contact you with the information?

Yes (please supply email address)     
No

 

How can we improve the site? (You may write as much as you like.)

 

Are you a:

Caregiver
Professional in aging or other related discipline
Both

 

If you are a professional in aging or other discipline, do you use this site for work?

Yes
No

 

If you are a caregiver, it would help us to know some basic information about who you are and the person for whom you are caring. This information will help us to know how to focus our efforts. Your time is greatly appreciated.

 

In what type of area do you live?

Rural
Urban

 

Which best describes where the care recipient lives?

in your home
in your city or area
in your state
in another state

 

Age of care recipient:

Under 50 
50-59
60-69
70-79
80-89
90-99
100 or older

 

Are you the only caregiver?

Yes
No     If no, how many other assist?

 

Does the care recipient have disabilities?

Yes   If yes, please indicate type:

No

 

What is your gender?

Male
Female

 

What is your age?

20-29
30-39
40-49
50-59
60-69
70-79
80 or over

 

What is your education?

High School
Some College
Associate Degree 
Bachelor's Degree
Master's Degree 
Doctorate Degree
Other (please specify):  

 

Is there anything else you would like to share?
(You may write as much as you like.)

May we use your comments related to what you think of the site (i.e. no personal information) to promote the site?

Yes   
No

If yes, may we also use your name and state?

Yes    (please provide name below, if checked)
No

 

Your Name:   (optional)

Your E-Mail: (optional)

*City:        

*State:    * Country:    

* Required to help us know where people are located who need the information.

Enter the 6 letters shown in box, then click Submit:

Thanks!

 

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