Senior Mobility Program Question Title * 1. Are you aware that the the City of Laguna Niguel offers a Senior Mobility Transportation program for seniors? Yes No Question Title * 2. If you marked YES to the previous question, are you currently registered for the Senior Mobility Program? Yes No Question Title * 3. If you are registered for the Sea Country Senior and Community Center's Mobility Program, how long have you been a member? 0-1 Years 1-2 Years 2-3 Years 3+ Years Question Title * 4. Please read the following statements and mark all the apply. I use the SMP Transportation Program because the program offers transportation to locations that I need to access. I use the SMP Transportation Program because the program is affordable. I use the SMP Transportation Program because the program makes me feel comfortable. I use the SMP Transportation Program because it is the only mode of transportation I have access to at this time. I use the SMP Transportation Program because I primarily use it to visit the Sea Country Senior and Community Center. I use the SMP Transportation Program because it meets all of my transportation needs. I use the SMP Transportation Program because it provides access to my medical provider. Question Title * 5. Have you found this service to be helpful in your day-to-day activities? Yes No If no, please explain: Question Title * 6. Have you used this service to go to non-emergency medical appointments? Yes No If yes, how many trips per month: Question Title * 7. Where are your medical appointments primarily located? List all that apply: Question Title * 8. Have you used this service to go to shopping centers within the city of Laguna Niguel? Yes No If yes, how many trips per month: Question Title * 9. If available, would you use this service to visit friends and/or family, or to attend social gatherings within the city limits of Laguna Niguel? Yes No Question Title * 10. If available, would you use this service to attend large scale community events within Orange County? Yes No Question Title * 11. If we were to provide service to anywhere in Orange County, where would you like to be able to go? Question Title * 12. Are there any areas you would like to travel to outside of Orange County? Question Title * 13. Is there any additional feedback the you would like to share about the transportation program or recommendations that you would like to make for consideration? Question Title * 14. The following section is not required, but will allow us the opportunity to contact you regarding your feedback to further address or clarify responses. This section is optional, but is strongly recommended if you would like any follow-up from City staff. Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Done