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Assessment

Assessment

Take this assessment to help you understand your risk level and receive helpful information and recommendations based on your results.

Are you taking this survey for yourself or are you taking it on behalf of someone else?

* Required

Please rate your level of agreement with the following statements:


I feel isolated from others

* Required

I lack companionship

* Required

I feel no one really knows me well

* Required

I can find companionship when I want it

* Required

In the past two weeks, I have participated in organizations such as: Social clubs, residents’ groups, or committees

* Required

In the past two weeks, I have participated in: Religious groups

* Required

I avoid socializing because it is hard to understand conversations, especially when there is background noise

* Required

I am satisfied with the relationships I have with my family

* Required

I am satisfied with the relationships I have with my friends

* Required

I have as much contact as I would like with people I feel close to and who I can trust and confide

* Required

There are enough people I feel close to and could call for help

* Required

I am content with my friendships and relationships

* Required

I miss having people around me

* Required

Please tell us a little about you. What is the 5-digit ZIP Code where you live?

* Required

In what year were you born (YYYY)?

* Required

What is your gender?

* Required

Are you of Hispanic, Latino, or Spanish origin or descent?

* Required

Which of the following best describes your race?

* Required

Do you live alone?

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Are you married or do you live with a partner?

Have you ever served in the military?

* Required

Are you blind or do you have difficulty seeing, even when wearing glasses?

* Required

Are you deaf or do you have difficulty hearing?

* Required

Do you have difficulty walking or climbing stairs?

* Required

Are you worried or stressed about having enough money to meet your basic needs?

* Required

Do you have a ride or the transportation you need to get where you want to go?

* Required

Do you own a smartphone, computer, laptop, or tablet?

* Required

Which of the following best represents how you think of yourself?

* Required
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