Let’s Talk Medicare "*" indicates required fields Step 1 of 2 50% Today's Date MM slash DD slash YYYY Birthday * Required MM slash DD slash YYYY Enter required information below. * Required First Last Email * Required Phone * RequiredResidence County * RequiredBentonWashingtonMadisonBaxterBooneCarrollIzardMarionNewtonSearcyStoneotherProfession * RequiredPublic/CommunityDieticianMedical StudentNursingNursing Home AdministrationParaprofessionalPatientPhysical TherapyPhysicianResidentSocial WorkStudentGender * RequiredMaleFemaleOtherRace * RequiredAfrican-AmericanAmerican IndianAsian/Pacific IslanderCaucasianHispanicMiddle EasternOtherHow did you learn of this program?(check all that apply) Facebook Website Word of Mouth My Center on Aging (the Schmieding Center) My Healthcare Provider (e.g., doctor, nurse, etc.) Other Survey data is required by our funder to offer this program at no cost to participants. Only aggregate (group) data from this survey is reported.How would you rate your overall knowledge of Medicare? * Required Excellent Good Fair Poor SCSHE How would you rate your understanding of what the various parts of Medicare cover? * Required Excellent Good Fair Poor SCSHE How would you rate your understanding of the costs associated with Medicare enrollment? * Required Excellent Good Fair Poor SCSHE How would you rate your knowledge of how to access resources to help with Medicare planning and questions? * Required Excellent Good Fair Poor SCSHE How would you rate your confidence in choosing a Medicare plan that works for you? * Required Excellent Good Fair Poor SCSHE
