* 1. Are you currently a:

* 2. When did you serve in the armed forces? (please specify years):

* 3. What is your primary means of transportation?

* 4. If you do not currently use transit (local bus service) for transportation, why not?

* 5. Do you have transportation accommodation needs? (wheelchair, etc.)

* 6. What is your biggest transportation challenge?

* 7. Do you currently receive or utilize any VA services?

* 8. Do you know if you are entitled to VA Benefits?
(If no, please skip to next question)

* 9. Do you know how to find out information about benefits you may be entitled to?

* 10. Did you know that there is a new VA Outpatient Clinic in Cape Coral?

* 11. Which VA medical facilities do you use? (Check all that apply)

* 12. Do you have internet access (computer or other internet-enabled device)?