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Dragon Hall Contact Response
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* Indicates required question
Email
*
Your email
Do you have a smartphone
Yes
No
Clear selection
If yes, what model is it
Apple
Google
Samsung
Other
Clear selection
What is your preferred contact method
Email
Phone Call
Text Message
Whatsapp
Clear selection
Regarding our Daily updates. What topics are most useful / interesting to you
FOOD / SHOPPING
HEALTH
ART & CULTURE
None of the above
Do you use any of the following software
FaceTime
Zoom
Skype
Other
None of the above
Other:
If you answered 'none of the above', please tell us why
Your answer
Would you be interested in learning how to use FaceTime, Zoom or Skype?
Yes
No
Maybe
Clear selection
Are you living on your own?
Yes
No
Clear selection
How would you rate your current physical health
Good
Average
Poor
Other:
Clear selection
How would you rate your current mental health
Good
Average
Poor
Other:
Clear selection
Do you need any support with the following:
Shopping
Medication
Laundry
Other:
Is there anything that you would like to add that has not been covered in the questions above or do you have any other suggestions or comments.
Your answer
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