Participate in an interview

Assistive Robotics is in a search process to identify customers for solutions that will help senior citizens and other people with ambulatory disabilities to maintain their independence in their own homes.

Please fill out the form below. At the minimum, we need to know your name and phone number at which we can reach you. If you are in the metro Detroit area, we would prefer conducting the interview face-to-face.If we cannot reasonably get to you, we may choose to conduct the interview by phone or online conference (e.g. Skype).

First name: 

Last name:

Best telephone number to reach you:

Which of the following categories best describes your interest in solutions to fall risks among older adults and others who are prone to falls:
I want to stay in my home, but I worry about falling and then losing my independence.
I worry about my loved one's safety, and want to honor her/his desire to remain independent but with better solutions for preventing falls.
I am a healthcare provider who wants to reduce mortality and morbidity rates, especially among my older patients, and a solution that effectively lessens fall risks would be very interesting to me.
I'm a dealer/distributor of home medical devices, and am interested in devices that would improve my customers' health, safety, and quality of life.
Other

If you answered other, please tell us a little about your interest in our work.

Would you like receive by e-mail regular updates on our work?
Yes
No
E-mail address: 

Please take a moment to provide us some basic demogrographic data. These are to be used only in aggregate to help us know how to focus our development activity.

Gender:
Male
Female
Prefer not to answer

Age: