How Long have you been considering senior living as an option?

0–3 Months

4–7 Months

8–12 Months

Longer

Is your family, spouse and other trusted advisors supportive of senior living as a lifestyle option?

Yes

No

Some are and some aren't

What is most important to you in choosing a senior living community? Select all that apply.

Supporting my current and/or future health

Increasing my opportunities for social interactions

Helping me care for my loved one

Reducing the care required from my family

If there is a concern you have that isn't in this list, you can write it here:

What concerns you most about choosing a senior living community?

Affordability

Fitting in

Downsizing

Leaving our long term home

Loss of privacy

If there is a concern you have that isn't in this list, you can write it here:

What features/amenities will be most important to you?

Pool

Educational classes

Space to celebrate with family

Exercise or physical training space

Trips to local events

Planned social events

Dining venues

Pub/Coffee shop/Community store

Salon

Outside spaces

If there are other features/amenities that aren't in the list, you can write list them here:

What home features will you value most?

Size of apartment

Upgraded kitchen and bathroom countertops and cabinetry

Closet space

View

Outside sitting area (balcony/patio)

Room for my stuff

If there are other home features that aren't in the list, you can write list them here:

What do you like to do for entertainment or fun?

Outdoor physical activity

Pool/Swimming

Reading

Movies

Socializing

Sporting events

Concerts/music

Coffee breaks

Television

Computer/virtual visits

Church

Volunteering

Travel

Shopping

Are you a member of any clubs or civic organizations? If so, which ones?

Will you be bringing a pet? If so, tell us a bit about your pet friend.

Do you know anyone who is currently living in a senior living community?

Yes

No

On a scale of 1-10 how ready are you about experiencing the benefit of senior living?

What is your first name? *

What is your last name? *

What is your mobile phone? *

What is your email address? *

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