The purpose of this survey is to gather information from the maternal and child population of Lucas County 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. I am:

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* 2. What is your zip code?

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* 3. Including you, how many people live in your household?

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* 4. How many children (18 & under) live in your household?

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* 5. Approximately how many health related appointments do you and/or your child have in a year?

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* 6. How do you get to your health care related appointments? (Mark all that apply)

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* 7. Do you have trouble making an appointment or keeping an appointment because of transportation issues?

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* 8. If you are having transportation issues, what issues are you facing? (Mark all that apply)

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* 9. Do you feel that missing an appointment has had a negative health impact on you or your child?

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* 10. Do you feel that there is anything that health care providers can do to help with your transportation issues?

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* 11. Do you know what resources are available to you if you need help with transportation to an appointment?

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* 12. Do you have any other comments to share about problems with transportation to health related appointments? If you have any stories that you would like to share about this issue please include them below.

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