Access Paratransit Service Questionnaire

We have received complaints about persistent and serious problems with Access Services ("Access"). Please help us better understand these problems and try to solve them by completing this survey.

If you need assistance and/or accomodations to complete this survey, please contact DRLC at access@drlcenter.org, or cal (213) 736-1031.

Please submit completed surveys by 02/08/2021.

Biographical Information

The following questions are optional. Please complete the following questions to the best of your ability. If you do not wish to provide the requested information, please leave the appropriate response area blank. If the answer is not applicable to you or you do not know the answer, please skip this question.

Question Title

* 1. Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Age

Question Title

* 3. Secondary Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 4. Do you have a disability?

Yes

If yes, please specify

Question Title

* 5. Do you use a mobility device?

Yes

If yes, please specify:

Question Title

* 6. Do you use a caregiver?

Yes

Sometimes

If yes or sometimes, please provide name, phone, email and address of caregiver

Question Title

* 7. Do you use a service animal?

Yes

Sometimes

If yes, please specify what kind of service animal: