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Screener Registration Survey

Welcome to Live Well at HomeSM.  Thank you for using the Live Well at Home Rapid Screen©. To register with the Minnesota Board on Aging as a Live Well at HomeSM screener, please complete this short survey.Your personal information will not be published. Key information and materials for screening are found at www.mnlivewellathome.org (right tab "Calling All Screeners")

Q1Please indicate if you would like to be added to our mailing list.

Screener Checklist:

Q11Have you read the document,"What is a Live Well at HomeSM Screener"?
Q12Did you watch the  "Risk For Moving to Nursing Home” video (1.6 minutes) found on the website's home page and, the “Dollie and Marjorie" video (2.59 minutes) found under Stories and Videos tab?  
Q13Did you complete the “Live Well at Home Rapid Screen© Training” learning module (8.54 minutes) found under the "Calling All Screeners" tabs?
Q14So you have constant access to the screen, have you downloaded the Live Well at Home Rapid Screen© mobile app to your mobile device?(see home page)
Q15Have you attended a Minnesota Board on Aging or Area Agency on Aging sponsored training on Live Well at HomeSM?
Q18Did you practice the Live Well at Home Rapid Screen© with 5 or more adults including the proxy version?

Thank you for completing this survey and registering as a Live Well at HomeSM screener.The  Minnesota Board on Aging encourages you to voluntarily report your screening data through the websites"Calling All Screeners" button. This information is useful as the state works to support older adults and family caregivers.  Please also add your organization’s information to www.minnesotahelp.info

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