ASHA CARE HOMES
ASHA SENIOR LIVING1st Floor, Koluthara Towers, near Marappalam, Pattom, Trivandrum, Kerala, India1800-102-8313/ +91-9633959632 www.ashacare.in / info@ashacare.in
SURVEY TO UNDERSTAND THE AWARENESS AND ACCEPTANCE OF SENIOR LIVING FACILITIES IN KERALA
PERSONAL INFORMATION
Please Note : Kindly Share your contacts only if you are interested in our services. Otherwise kindly mention only your name and indicate other details as ' NIL'
Name *
Age & Gender
Occupation
Email ID
Contact No
Currently Residing at
Name of Residential Association
1. Who all live in your home (other than yourself)? *
Required
2. Where do your children live? *
3. Are you aware about any Senior living facilities? *
3. 1 If Yes for Question 3, Please share the details of the Senior living facility you are aware of
4. Would you like to consider moving to a Senior Citizens community sometime? *
Required
5. For whom would you like to opt a Senior Living facility? *
6. What type of living will you or your loved one prefer? *
7. We are planning to open up a new facility in Trivandrum. According to you, what all facilities are required for the residents in the property? *
8. We offer many amenities such as fitness programs, extensive opportunities for socialization and alternative wellness modalities such as swimming pool that are unique to our community. Please select your choice of facilities. *
Required
9. How much do you think would be an appropriate pricing per month(in Rs) based on the facilities you have chosen in question 8? *
10. Are you aware about some senior citizen who would be requiring / waiting to move in to a Senior Living Facility? (please share their contact details )
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