Area Agency on Aging for Lincolnland

In order to help us provide a better range of services to seniors in our area, we ask that you please take a few moments to fill out our survey and submit it to us by e-mail. If you would like all information you provide to be kept strictly confidential, simply do not answer the optional questions regarding name and address.

1) Are you looking for information for yourself?
(click if YES)

For a family member? (click if YES)

2) Are you are a "long-distance caregiver," living more than 50 miles from the person you care for? (click if YES)

3) What are your major concerns related to aging and available services?

(type your major concerns here)

4) Is our website your first contact with the aging network? YES NO

5) Did this site give you the information you were looking for? YES NO

6) Do you have other aging-related questions?

(type other questions here)

Would you like to request a brochure listing senior services in a specific county in our service area? 7) YES NO

If yes, you must fill in the following, and a brochure will be mailed to you as soon as possible.
If no, then the following information is optional.

County you would like a brochure for:
Your Email:
Your Name:
Street:
City:
State:
Zip Code: