In which municipality do you live?

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* 1. In which municipality do you live?

Gender

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* 2. Gender

You live ...

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* 3. You live ...

Your age group is :

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* 4. Your age group is :

Do you feel Good at home ?

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* 5. Do you feel Good at home ?

Name 3 measures that appear the most important to live a home as long as possible :

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* 6. Name 3 measures that appear the most important to live a home as long as possible :

If you or your spouse's health forced you to move, where would you hope to live?

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* 7. If you or your spouse's health forced you to move, where would you hope to live?

In your present home, do you feel safe facing the following dangers

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* 8. In your present home, do you feel safe facing the following dangers

  Not secure at all Little Secure enough Very secure
fire
theft
vandalism
fraud
flooding
great heat
great cold
intimidation
MUTUAL AND INTERGENERATIONAL CONNECTIONS

In the last year have you used or participated at:

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* 9. MUTUAL AND INTERGENERATIONAL CONNECTIONS

In the last year have you used or participated at:

  Never 2-3 times/year Every month Every week
Library
Petanque game
Shuffleboard
Arena
Community center
Group outings outside of area
Municipal festivities (Canada Day, Christmas, Festival, etc.)
Internet access center
In the last year, did you do any volunteering

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* 10. In the last year, did you do any volunteering

  Never 2-3 times/year Every month Every week
For other seniors
With young families
With a local organization
With a community organization (Popote, CABBE, etc.)
With members of your family
During the next year, would you like to volunteer

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* 11. During the next year, would you like to volunteer

  Never 2-3 times/year Every month Every week
For other seniors
With young families
With a local organization
With a community organization
With members of your family
WORK AND RETIREMENT

If you are retired...

If you had the possibility to return to the work force, would you be interested in

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* 12. WORK AND RETIREMENT

If you are retired...

If you had the possibility to return to the work force, would you be interested in

  Not at all Maybe A lot
Part time job (less than 20hrs./week)
Full time job
Occasional job (less than 6 months/year)
If you are still working...

If your job or your actual employer would allow, would you be interested in

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* 13. If you are still working...

If your job or your actual employer would allow, would you be interested in

  Not at all Maybe A lot
Part time job (less than 20 hrs/week)
Continue to work full time
Occasional job (less than 6 months/year)
Change jobs
If you are a farmer or if you know some farmer...

Which of the following statements corresponds the best to the current concerns of people in agriculture

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* 14. If you are a farmer or if you know some farmer...

Which of the following statements corresponds the best to the current concerns of people in agriculture

HEALTH


I am well informed on the health care offered in Bedford

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* 15. HEALTH


I am well informed on the health care offered in Bedford

I need to go out of Bedford, but in Brome-Missisquoi to get health care

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* 16. I need to go out of Bedford, but in Brome-Missisquoi to get health care

I have problems with transport to receive health care

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* 17. I have problems with transport to receive health care

I am satisfied with the health care offered in Bedford

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* 18. I am satisfied with the health care offered in Bedford

I am satisfied with the health care offered in the Brome-Missisquoi territory

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* 19. I am satisfied with the health care offered in the Brome-Missisquoi territory

I receive support to take care of a person of my entourage

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* 20. I receive support to take care of a person of my entourage

If so, I receive this support from

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* 21. If so, I receive this support from

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