Living Well: What Do You Need?
What we need to live well and stay healthy changes as we age. It's important that people responsible for providing coverage and care to seniors have a clear picture of what you need to feel good, stay connected in your community, and live independently.
Thinking ahead to a time when your health may not be as good as it is today, what kinds of supports would you like to have available that would make it easier for you to remain independent at home? *
[Please check all that apply, and add your own suggestions]:
Required
We know that being healthy is just one part of living well. What other things are important to you? *
[In a few sentences, describe what "living well" means to you]:
Your answer
What do you wish your health care providers understood about you? *
[Please check all that apply]:
Required
Has there ever been a time when you felt frustrated or alone in trying to get help for medical problem?
[Please tell us a little bit about what happened, who you turned to for help, and if your problem was resolved]:
Your answer
Who do you call when you need help with a health care problem? *
[Please check all that apply]:
Required
Your Name *
Your answer
Your Email *
Your answer
Your Phone *
Your answer
Your Zip Code *
Your answer
What kind of health coverage do you have? *
[Check your insurance card if you're not sure, and please select the programs you're enrolled in]:
Required
Have you heard anything about Community HealthChoices? *
[Community HealthChoices is a new effort to improve the quality and coordination of care through a managed-care delivery system]
Please select your age group below:
[None of this information will be shared publicly]
Please select your race:
[None of this information will be shared publicly]
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