SeniorSync Assessment Form

First Name

Last Name

Date of birth

Address

City

State

Insurance Provider

Email *

Phone *

*Technology Experience

1. How comfortable are you using mobile devices (smartphones, tablets)?

Very comfortable

Somewhat comfortable

Not very comfortable

Not at all comfortable

2. Which of the following apps do you currently use?

Messaging (e.g., WhatsApp, Messenger)

Social media (e.g., Facebook, X, Instagram)

Video calling (e.g., FaceTime, Skype)

Health tracking

Entertainment (e.g., streaming services)

Other

3. Do you currently use any voice assistants (e.g., Alexa, Google Assistant)?

Yes

4. Are you familiar with any robotics devices or home automation systems?

Yes

Test Challenges:

5. What are your biggest challenges when using technology?

Setting up new devices or apps

Understanding how to use certain features

Staying safe online (e.g., avoiding scams, protecting personal information)

Keeping devices updated and secure

Other

Tech Goals:

6. What are your goals for improving your tech skills or using technology more effectively?

Communicating with family and friends

Managing health and wellness

Accessing entertainment and information

Simplifying daily tasks (e.g., shopping, banking)

Other

Additional Information:

7. Is there anything else you'd like us to know about your technology needs or preferences?

Your response

8. How frequently do you encounter technical issues with your devices or apps?

Rarely

Occasionally

Frequently

I'm not sure

9. Do you have any specific preferences or concerns regarding privacy and security when using technology?

Yes

10. Would you be interested in attending workshops or training sessions to improve your technology skills?

Yes

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Text Opt-in

By providing my mobile number, I consent to receiving automated texts from SeniorSync for informational and marketing purposes. Message frequency may vary. Consent to receive texts is not required to use ReinoLogistics services, and I can opt out at any time by replying “STOP” to any text message. Standard message and data rates may apply.

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