Survey

Platte Senior Services is in the process of reactivating and expanding our services to satellite locations within Platte County. Weston, Platte City, Parkville, and Riverside are in the beginning stages.

We have created a survey to determine senior’s wants and needs. Please take a moment to answer the following questions and submit this survey.

Thank you for your time and consideration!

Platte County Senior Services Inc Survey

What other activities or exercise programs or special events would you consider attending if offered at PSSI or satellite centers.

Please circle the distance you are willing to travel from home.

Approximately how many times a week do you participate in social events outside of medical appointments?

How many days would you like to get out per week?

Would you be interested in participating in a restaurant voucher program where you use a voucher and order off a special menu? This program is based on a voluntary contribution when you enroll.

Yes

No

Do you have Transportation?

Yes

No

What method of transportation do you use?

Carpool

Share Ride

Drive oneself

OtherOther

Age of person completing this form

Location of person completing this form (City)

If you are human, leave this field blank.

Again, thank you for your participation.

Sincerely,

Anne M. Rogers
Executive Director
Platte Senior Services Inc