Old Age Well-Being Survey
  • Name
  • Date of birth
  • Gender
  • Occupation
  • Have you started planning for retirement?
  • please specify why:
  • Are you confident of a comfortable retirement ?
  • How comfortable are you with your savings?
  • Do you have any outstanding loans/payments? Check all that may apply.
  • What have you done in preparation for retirement? Check all that may apply.
  • How often do you go for health checkups?
  • Do you have any long term illnesses?
  • please specify:
  • Do you have healthcare benefits?
  • please specify what type:
  • Do you have insurance?
  • please specify what type
  • What are your biggest concerns about old age? Please specify below.
  • What could be done to improve your situation? Please comment below.

That's all, folks!