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Satisfaction Survey
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* Indicates required question
Age:
*
55 - 64
65 - 70
71 - 79
80 and above
Sex:
*
Female
Male
Number of years using COA services:
*
0 - 1
2 - 4
5 - 10
11 or more
Type of service used:
*
Transportation
Information Resource
Income Tax Return
In Home Care
SHIP/Medicare Counseling
Activity Center
Money Management
Required
How often do you use a transportation service
(either COA or another provider):
*
1 - 3 times/week
Once a month
Every two months
Seldom
Never
How do you pay for services:
*
Private pay
Medicaid
Other funding provided by COA
Required
How likely are you to refer a family member or friend to Council on Aging:
*
Yes
No
Maybe
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