Age Friendly Survey About Yourself Question Title * 1. Which gender do you associate with: Male Female Other Question Title * 2. I live in Hastings and St Leonards Yes No Question Title * 3. I regularly visit or work in Hastings and St Leonards Yes No Question Title * 4. Please enter your postcode: Question Title * 5. Which of the following age groups do you belong: 50-59 60-69 70-79 80+ Question Title * 6. Do you consider yourself to have a disability: Yes No Question Title * 7. If 'yes' to Q.5 what disability - tick all that apply Hearing Visual Physical Mental Long-term Question Title * 8. How would you rate your quality of life: Very good Good Poor Very poor Question Title * 9. Are you currently employed: Full time Part time Unemployed Retired Question Title * 10. Are you unable to work due to: Disability Health I'm a carer Other Question Title * 11. Do you currently live: Alone With spouse/partner With family With others non-related Question Title * 12. Do you receive home care: Yes No Next
