1. Are you currently a:

2. When did you serve in the armed forces? (please specify years):

3. What is your primary means of transportation?

4. If you do not currently use transit (local bus service) for transportation, why not?

5. Do you have transportation accommodation needs? (wheelchair, etc.)

6. What is your biggest transportation challenge?

7. Do you currently receive or utilize any VA services?

8. Do you know if you are entitled to VA Benefits?
(If no, please skip to next question)

9. Do you know how to find out information about benefits you may be entitled to?

10. Did you know that there is a new VA Outpatient Clinic in Cape Coral?

11. Which VA medical facilities do you use? (Check all that apply)

12. Do you have internet access (computer or other internet-enabled device)?

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