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South Haven Area Senior Services
220 Broadway, South Haven, MI 49090
Office Hours: Monday - Friday  9:00 a.m. to 4:00 p.m.
Phone: 269-637-3607  Toll Free: 1-866-627-8904
Email: shassinfo@i2k.com
 

  

"A Survey to Weigh the Needs
of Area Seniors"

Please take a few moments
to fill out the form below.  In so doing you will contribute greatly
in assisting SHASS to further define the needs, wants, and desires of
the senior population within our service area.  Thank you for caring!
 Please remember to fill in the white boxes below with your name, address,
township, phone, email, etc.  We need such information to make this
a viable survey.  Thanks again, ted

Please click, Yes or No below.....

Are either you or your spouse a senior?  That is to say, age 60 or older?

 Yes   No

Other than you or your spouse, do you have a senior residing in your home?

 Yes   No

If the answer to either query above is "Yes," there is the likelihood that one or more of your
household will benefit from needed assistance or information concerning the following
health issues or services.
Care Watch :  Yes   No
Health Services:  Yes   No
Nutritional Services:  Yes   No
Giving Donations to SHASS:  Yes   No
Community Connections:  Yes   No
Senior Activities:  Yes   No
Volunteer Opportunities:  Yes   No

Home Phone:

Your Web Site Address:
If available, for our "Links Page":

Your Email Address:

Any additional Comments, Questions, or Suggestions may be entered in box below;

Check your information for correctness, then click the Submit Button below.
Within moments you will be directed to a "Confirmation Page," where you
will indeed see confirmation that we have received your information.
Within 2 working days, you will be contacted by our office
to see how it is, that we may help you!  Thank you.
Note also, when you return here from the Confirmation Page, that
all your information has been cleared from this form. thanks again!


 


 


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