Elder Abuse Survey

Potential Elder Abuse Survey

Thank you for joining our survey. Please give us your feedback!
Have you conducted a comprehensive misconduct search on your caregiver?

YESNOUNKNOWNDOES NOT APPLY
Are you aware of any dramatic changes in bank account balances or banking practices?

YESNOUNKNOWNDOES NOT APPLY
Are you or someone on your behalf conducting regular visits and having in person contact with your loved one?

YESNOUNKNOWNDOES NOT APPLY
Has there been a new friend or trusted acquaintance attempting to make decisions on the elderly person’s behalf?

YESNOUNKNOWNDOES NOT APPLY
Have you noticed any unauthorized or unexplained financial account withdrawals?

YESNOUNKNOWNDOES NOT APPLY
Does the caregiver or agency have access to checks, credit cards, cash, jewelry, or other property?

YESNOUNKNOWNDOES NOT APPLY
Has the elder person complained about the disappearance of funds or valuable possessions?

YESNOUNKNOWNDOES NOT APPLY
Has the elder made an unanticipated transfer of assets to a family member or friend?

YESNOUNKNOWNDOES NOT APPLY
Have there been any sudden changes to a will, trust, or important financial documents?

YESNOUNKNOWNDOES NOT APPLY
Has your loved one become distant and detached/shown new signs of depression or being withdrawn?

YESNOUNKNOWNDOES NOT APPLY
Does the caregiver resist or refuse to allow you and your loved one to be alone for private conversations?

YESNOUNKNOWNDOES NOT APPLY
Has your loved one claimed to be threatened or afraid of doing something wrong?

YESNOUNKNOWNDOES NOT APPLY
Does your loved one have unexplained soreness, upper arm, bruises on the wrists, back, neck, or on the bottom of the feet?

YESNOUNKNOWNDOES NOT APPLY
Are you willing to file criminal complaint if fraud, embezzlement, or abuse is identified and documented?

YESNOUNKNOWNDOES NOT APPLY
Have you considered a random financial records examination?

YESNOUNKNOWNDOES NOT APPLY
What is your e-mail so we may send you your results and your $50 credit code?
example@example.com
Please submit your name and organization
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Potential Elder Abuse Survey