The purpose of this survey is to gather information from organizations in Lucas County that work primarily with women and children to help determine if transportation issues affect residents’ health by impacting their ability to make and keep health related appointments. The information provided will be used to develop recommendations for improving access to health care in the community.

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* 1. Organization Name

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* 2. Approximately how many Lucas County residents do you serve in a year?

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* 3. How would you best describe your clients? (Mark all that apply)

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* 4. Do you feel that transportation barriers keep your patients from making and keeping health related appointments?

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* 5. If you answered yes to question 4, what are the barriers? (Mark all that apply)

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* 6. If you have a client call to ask for help getting transported to a health care related appointment, how would you respond? (Mark all that apply)

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* 7. Do you feel that your staff understands the transportation options available to help Lucas County residents?

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* 8. What options would be a helpful transportation resource for your staff? (Mark all that apply)

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* 9. Do you have any other comments to share about the lack of transportation and how it affects your clients in regards to their health related appointments?

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