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Blueprint for Healthy Aging in NJ Feedback
Questions that require an answer are marked with a *.
Please help us evaluate the Blueprint by completing this survey. To thank you, you will receive free educational materials designed to help older adults in their efforts to make healthy choices.

Questions or Comments? Contact Sue Lachenmayr, NJ Department of Health and Senior Services

Phone: 609-292-9152

Email: susan.lachenmayr@doh.state.nj.us
1. Please check the box that describes the Blueprint's usefulness to you or your agency about:
   
 Not UsefulSomewhat UsefulVery Useful
Benefits of healthy behaviors for older adults
County-specific data on health behaviors and health status of older adults
Cost-effective, evidence-based model programs for older adults
2. Please check the box that describes how likely you or your agency are to use the Blueprint to:
   
 Not LikelySomewhat LikelyVery Likely
Inform community partners about the importance of health promotion for older adults
Support older adult healthy behaviors in your community
Use county data to plan, implement and evaluate older adult health promotion programs
Expand your community's capacity to prepare grant proposals to support healthy aging
Improve your community's health status through policies and programs to prevent, delay and lessen chronic disease among older adults
3. Please share any additional comments about the Blueprint
   
*4. Your Name
   
*5. Agency
   
6. Street Address/PO Box
   
*7. City
   
8. State
   
9. Zip Code
   
10. County
   
11. Please send free healthy behavior materials for older adults.

If you select 'yes', make sure that you have supplied us with your full name and mailing address.

   
Yes
No
Thank you for completing this survey.
New Jersey Department of Health and Senior Services, PO Box 360, Trenton, NJ 08625-0360
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