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II. SUB-SAMPLE SURVEY PROFORMA
(for those not registered in the study)
Name : Sex : SSS No. :
Age : Village :  
1. Are you aware of the geriatric clinic functioning at Kallandiri PHC/ Sub-centres/ GRH?
Yes 1
No 0
If yes, reasons for not getting registered  
Felt it is no way better than PHC/ Sub-centre 1
Felt not necessary 2
Was not ill 3
Felt that it would not be of any help to me 4
Felt that nothing special could be offered 5
   
2. Where do you take treatment for your physical ailments?
PHC/ Sub-centre 1
GRH/ Others 2
Private practitioner 3
Indigenous medicine 4
Others (specify)  
None 0
   
3. Are you satisfied with the treatment?
Yes 1
No 0
If yes, reasons  
It is very near 1
Easily accessible by bus 2
It has more facilities 3
Doctor regularly available 4
More drugs 5
Others (specify)  
If no, reasons  
It is far away 1
Inadequate treatment facilities 2
Doctors not available regularly 3
Others (specify)  
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