#H2020 Senior Center (SC) Survey
Community senior social daycare, coming soon to Houston, with halal food, transportation and social get togethers. For any further details, comments, suggestions, you can email contact@houston2020.org
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Email *
Name of Senior *
Cell# *
Age *
Zip code *
Would you attend regular senior activities (like 6-8 hrs a day, 4-5 days a week) - subsidized pricing (with transportation & food & as covered by Medicare/Medicaid)? *
Languages you speak & understand
What medical insurance do you have? *
Required
How do you spend your time? *
Required
Do you take regular prescription medications? *
Dietary restrictions *
Do you have any comments or suggestions?
By submitting this information, I agree that all the information above is true to the best of my knowledge. All this information is voluntary and I will not hold #H2020 responsible for anything; and I understand that Community Senior Center will be a paid service established based on community interest and financial viability. *
Required
A copy of your responses will be emailed to the address you provided.
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