Survey Text

1980
1979
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1980
Survey form view entire document:  text  image
(1) An artificial arm?
[] Y
[] N
(2) An artificial leg?
[] Y
[] N
(3) A brace of any kind? (If "Yes" ask: On what part of the body is the brace worn?)
[] Y
[] N
(4) Crutches?
[] Y
[] N
(5) A cane or walking stick?
[] Y
[] N
(6) Special shoes?
[] Y
[] N
(7) A wheel chair?
[] Y
[] N
(8) A walker?
[] Y
[] N
(9) A guide dog?
[] Y
[] N
(10) Any other kind of aid for getting around?
[] Y
[] N

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1979
Survey form view entire document:  text  image

8a. Does anyone in the family (this is you, your, -- etc.) now use (any of the following special aids) -
If "Yes, " ask 8b and c

(1) An artificial arm?
[] Y
[] N
(2) An artificial leg?
[] Y
[] N
(3) A brace of any kind? (If "Yes" ask: On what part of the body is the brace worn?)
[] Y
[] N
(4) Crutches?
[] Y
[] N
(5) A cane or walking stick?
[] Y
[] N
(6) Special shoes?
[] Y
[] N
(7) A wheel chair?
[] Y
[] N
(8) A walker?
[] Y
[] N
(9) A guide dog?
[] Y
[] N
(10) Any other kind of aid for getting around?
[] Y
[] N