What aspect of aging concerns you most?
Physical health Memory loss Independence Loneliness Financial security
Which area would you like to improve in your aging process?
Physical fitness Cognitive abilities Emotional well-being Financial planning
What activities do you believe can enhance your aging experience?
Exercise Mental puzzles Social gatherings Therapeutic hobbies Financial management
Which of the following support systems do you rely on most for aging concerns?
Family Friends Community groups Professional services No support system
How proactive are you in addressing aging-related issues?
Very proactive Somewhat proactive Neutral Not very proactive Not proactive at all
All set, how can we reach you?
Name
Email
Phone
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