Please take our survey...

At SeniorMag, we are always interested in finding out more about our readers so that we can determine what kinds of services to develop and help our advertisers understand who seniors are and what they are all about. 

We hope that you will take just a couple of minutes to fill in the form below and then click the "Submit" button at the bottom.  No personal information is collected and your response to this survey

How fast is your connection to the Internet?

I don't know 14.4K 28.8K 33K 56K Cable DSL Other

Which describes your age range?

Under age 50 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85 or above

Which describes your income range?

Under $25,000 $25,000 - $35,000 $35,000 - $45,000 $45,000 - $55,000 $55,000 - $65,000 $65,000 - $75,000 $75,000 - $100,000 $100,000 - $150,000 $150,000 - $250,000 $250,000 or above

Enter your two letter state code ( ex. New York = NY)

Which best describes your community where you live:

Urban

Suburban

Rural

Which best describes your marital status:	Single Married Widowed Divorced Separated

Which more accurately describes your home setting:

Choose one Own home Rent home Rent apartment Live with children Assisted living home

How would you best define your financial ability to retire?

Very comfortable - No needs, no wants, no worries
Somewhat comfortable - No major concerns but cannot do it all
Generally comfortable - No worries but need to be careful
Finances get somewhat sticky from time to time
Money is always tight - no wiggle room whatsoever
Always short - often go without some things I need

Aside from Medicare, do you maintain any health insurance?

Choose one Yes No Not sure

Do you own a private policy that provides for long-term care?

Choose one Yes No Not sure

Do you have a will?

Choose Yes - Up to date Yes - Needs to be updated Yes - But very old No Not sure

Where are your children living? (pick as many as apply)

No children - does not apply to me

One or more children living...

within 10 miles	within 500 miles
within 20 miles	within 1000 miles
within 50 miles	within 1500 miles
within 100 miles	within 2000 miles
within 200 miles	within 3000 miles
within 300 miles	in excess of 3000 miles

What services do you currently subscribe to?  (pick as many as apply)

None	In-home personal services
Maid service	Dry-cleaning p/u and delivery
Yard service	In-home medical care
Pool maintenance	Laundry services
Meal preparation	Errand service
Meal delivery	Driver service
Pharmacy delivery	Companion services
Grocery delivery	Financial assistance
Handyman services

Which services do you plan to employ within the next 2 years.  (pick as many as apply)

None	In-home personal services
Maid service	Dry-cleaning p/u and delivery
Yard service	In-home medical care
Pool maintenance	Laundry services
Meal preparation	Errand service
Meal delivery	Driver service
Pharmacy delivery	Companion services
Grocery delivery	Financial assistance
Handyman services

Which services would you opt for if money were not an issue? (pick as many as apply)

None	In-home personal services
Maid service	Dry-cleaning p/u and delivery
Yard service	In-home medical care
Pool maintenance	Laundry services
Meal preparation	Errand service
Meal delivery	Driver service
Pharmacy delivery	Companion services
Grocery delivery	Financial assistance
Handyman services

Do you plan or expect to move within the next 5 years?

Choose
I don't plan to move
I plan to move into a smaller house
I plan to move into a condo
I plan to move into an apartment
I plan to move in with one of my kids
I plan to move in with other family
I plan to move into an assisted living unit

What activities do you often do in an average day?  (pick as many as apply)

Work at place of employment	Listen to radio
Meet friends for social time	Read book
Talk to friends/family on telephone	Cook
Read magazine or newspaper	Garden
Pray/worship/devotions	Exercise
Check out web sites	Check email
Play computer games	Go shopping
Watch television	Go to church
Creative activity	Go to a movie
Listen to music	Hobby activity

 

How often do you travel out of town?

Choose More than once a week Weekly A couple of times per month Once a month Once every 2-3 months Once every 4-6 months Once every 6-12 months Every couple of years Almost never I never travel

If you do travel, what purposes do you travel for?  (pick as many as apply)

I don't travel	Vacation
Business	Visit family/friends
Recreation

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