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* 1. Is there anything about our buildings, entrances, waiting rooms, hallways, offices or parking lots that could be a barrier to service?

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* 2. Is there anything about the location of our buildings and offices that could be a barrier?

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* 3. Is there anything about how staff talk to people and act toward them that could be a barrier?

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* 4. Are the charges for services a barrier?

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* 5. Is there anything about our staff that could be a barrier?

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* 6. Is it difficult to communicate with our staff or read our material?

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* 7. Is there anything else that interferes with our ability to serve people?

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* 8. Comments:

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