Rush Generations

Please fix the following

Additional Information

Please check the responses that most accurately describe you:

Male
Female
Other
Divorced
Married
Separated
Single
Single living with significant other
Widowed
I am a caregiver.
I have a caregiver.
Neither of the above.
(power of attorney for health care, living will, etc.)

Medical Interests

Check up to 3

Alzheimer's Disease
Arthritis
Bone Health
Blood Pressure
Cholesterol
Cancer
Diabetes
Depression/Mental Health
Eye Health
Heart Health
Men's Health
Pain
Respiratory Health
Stroke
Women's Health
None
Other

Lifestyle Interests

Check up to 4

Arts
Collection
Computers
Crafts
Dance
Exercise
Movies
Music
Reading
Social Groups
Sports
Travel
Volunteering
None
Other

Resource Interests

Check up to 3

Abuse or neglect
Adult Day Services
Advance Directives
Benefit Screening
Caregiver Support and Information
Emergency Home Response
Hearing Dental Vision
Housing
In-home Services
Medicare/Insurance
Nursing Home Services
Prescriptions
Transportation
None
Other