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Your Time Matters — Receive a $10 Starbucks Gift Card!

Thank you for taking the time to share your thoughts with us! As a thank-you for completing this short survey, you will receive a $10 Starbucks gift card.


The survey takes approximately 5 minutes to complete. To receive your gift card, you must provide a valid email address at the end of the survey. Your gift card will be sent within 14 days of completing the survey.

Hyde Park Community Aging-in-Place Survey


We are exploring ways to help older adults remain safely and independently in their homes while enjoying a high quality of life.


We want to hear from the Hyde Park community about what aging in place means to you, what challenges you or someone you care about may face as you get older, and what services or resources would be most valuable.


Whether you are thinking about your own future, caring for a parent or loved one, or simply interested in making Hyde Park a great place to grow older, we want to hear from you.


Your feedback can help us better understand the needs and priorities of our community.


Please complete the survey in its entirety to receive your $10 Starbucks gift card.
* 1. Where do you currently live?
* 2. Please select your age range.
* 3. Who are you taking this survey for?
* 4. Which services would be most valuable to you?
* 5. What challenges are you experiencing—or expect to experience—as you get older and want to remain independent? (check all that apply)
* 6. How would you prefer to pay for services?
* 7. Which services would you be willing to use AND pay for?
* 8. What would you be willing to pay for a monthly membership providing access to selected services?
* 9. What would you be willing to pay for meal delivery? (per meal, including delivery)
* 10. What would you be willing to pay for transportation? (per one-way trip)
11. What other services should Montgomery Place consider offering to help older adults age in place?
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* 12. Would you be interested in learning more about services offered by Montgomery Place? If you select Yes or Maybe, please provide your contact information below so we can reach out with additional details.

Receive Your $10 Starbucks Gift Card


Thank you for completing the survey!

To receive your $10 Starbucks gift card, please provide the information below. A valid email address is required to receive your gift card. Your gift card will be sent within 14 days of survey completion.
Name:
0/50
Email:
0/50
Address and Phone:
0/250

You're almost done!


Thank you for sharing your thoughts. Once you click Submit Survey, your responses will be recorded.


Your $10 Starbucks gift card will be sent to the email address you provided within 14 days of completing the survey.
Submit Survey

To learn more about Montgomery Place and the services we offer, please visit our website.
 

Montgomery Place | 5550 South Shore Drive | Chicago, IL 60637 US

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