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Eldercare at Home
Feedback Form
We welcome your comments and questions. Please fill out the following form to contact us.
1. Which Chapter(s) of Eldercare at Home did you read?
*Note: to select more than 1 chapter, hold down the control key (Windows) or the command key (Macinitosh).
1. How to use Eldercare at Home to solve caregiving problems
2. Caregiving
3. Breathing problems
4. Bone weakness
5. Constipation
6. Dental problems
7. Diarrhea
8. Fever and infections
9. Hearing problems
10. Incontinence
11. Pain
12. Skin problems
13. Sleep problems
14. Vision problems
15. Weight loss and nutrition problems
16. Communication problems
17. Memory problems
18. Behaviors associated with dementia
19. Depression
20. Problems of daily living
21. Mobility problems
22. Helping with recovery from illness
23. Using medicines safely
24. Problems getting medical information
25. Getting help from your community
26. Choosing a nursing home
27. Advance Directives
28. Dying At Home
2. How well did the chapter(s) of
Eldercare at Home
answer the questions you had about this topic?
very well
fairly well
not at all
3. How likely are you to change something you do as a result of reading this chapter of
Eldercare at Home
?
very likely
somewhat likely
not likely at all
4. Are there any questions on this topic that this chapter failed to address?
5. What other information would help you as a caregiver?
6. How are you using
Eldercare at Home
?
as a caregiver/concerned other
as a healthcare provider
as a patient
7. Your email address:
8. Would you like to sign up for the FHA mailing list?
yes
no
9. Additional comments/questions
©2007 The AGS Foundation for Health in Aging. All Rights Reserved.
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