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* 1. Are you (or someone you're caring for) currently using a wheelchair?

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* 2. Are you (or someone you're caring for) currently using adaptive technology (or transferring devices) in a vehicle?

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* 3. What type of assistive transferring devices for vehicles do you come across in your community?

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* 4. What are some functions that your current device doesn’t address?

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* 5. Please rate how satisfied you are with your current accessibility device for transferring in or out of a vehicle?

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* 6. What are the barriers to you (or the one you care for) becoming independent in storing your wheelchair or transferring in and out of your vehicle with adaptive technology?

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* 7. What is the cost that you would pay for a device that could provide full independence with the wheelchair-to-car transfer, and storing your wheelchair? It is fair to note that current technology raises the price of the adapted vehicle by around $40,000 to $60,000.

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* 8. Please rate how confident you would be with buying an accessibility device for storing your wheelchair and transferring in and out of your vehicle independently from an automotive manufacturer (Ford, Chevrolet, etc.)

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* 9. Please rate how confident you would be with buying an accessibility device for storing your wheelchair and transferring in and out of your vehicle independently from an adaptive technology company?

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* 10. The information printed below is optional but much appreciated.

Customer name:                           
Customer phone number:
Customer email:

0 of 10 answered
 

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