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Questions marked with a * are required Exit Survey
 
 
* What do you think of  a seniors's transportation service?
Love It
Hate it
 
 
 
* How often do you  see yourself using this service?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
When and where might you need access this service ?
 
Doctor's appointment
 
Grocery Shopping
 
To go to a Movie
 
General Shopping
 
 
 
* What method of transportation do you use now (Select all that apply)?
 
Family Member
 
Family Friend
 
Taxi Service
 
Public Transportation
 
Friend

 
 
 
* How confortable would you feel to use this type of service?
 
 
 
Please indicate your gender?
 
Male
 
Female
 
Prefer not to answer
 
 
 
Please you indicate you age?
 
55 - 60
 
60 - 65
 
65 - 70
 
70 - 75
 
75 - 80
 
80 & over
 
Prefer not answer
 
 
 
Please Income range
 
10,000 - 15000
 
15,000 - 20,000
 
20,000 - 25,000
 
25,000 - 30,000
 
Prefer not to answer
 
 
 
Indicate level of mobility?
 
very mobile
 
limited mobility
 
Need assistance
 
 
 
Use of assisted device?
 
Cane
 
Walker
 
Wheel Chair
 
Rolater