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Quiz
Quiz
webmaster
2020-03-26T16:34:10-04:00
Step
1
of
6
16%
First Name
*
Last Name
*
Email
*
Phone
*
Are you or your loved one 55 years of age or older?
*
Yes
No
Are you or your loved one a permanent resident of Lee, Charlotte or Collier Counties?
*
Yes
No
Do you or your loved one receive less than $2,742 of income per month?
*
Yes
No
Not Sure
Do you or your loved one have less than $5,000 of assets (ex: cash, bank accounts – not including a house or car)?
*
Yes
No
Not Sure
Do you or your loved one need help with daily activities like walking, eating, preparing meals, showering, getting dressed, or taking medications
*
Yes
No
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