Disability Services in Galatia,IL
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• What is the nature of the disability? (Check all that apply)
  
  (1) Wheelchair, (2) Walker, (3) Impaired vision, (4) Impaired hearing, (5) Impaired strength/motion range (reaching, bending, lifting), (6) Sense of touch/dexterity (gripping, turning, twisting knobs etc.), (7) Loss of balance, coordination, (8) Sense of smell, (9) Cognitive issues (dementia, Alzheimer's, memory loss), (10) Other

• Where are you having trouble in the home? (Check all that apply)
  
  (1) Getting in and outside, (2) Moving from room to room, (3) Opening doors/turning knobs, (4) Getting up and down, (5) Hallway(s), (6) Bathroom(s), (7) Kitchen, (8) Stairs, (9) Closet(s), (10) Bedroom(s), (11) Lighting, (12) Floors, (13) Outdoors (garage, walkways, driveway), (14) Other

• What kind of residence is it?