* 1. Do you currently use public or shared transportation? (Check all that apply)

* 2. If it were an option, would you ever consider taking public or shared transportation to medical appointments?

* 3. If you answered “Yes” to Question #2
a. what factors would be most important to you? (Check all that apply)

* 4. If you answered "Yes" to Question #2
b. what types of transportation would you be most interested in? (Check all that apply)

* 5. If you answered "No" to Question #2
Why not?

* 6. Are you currently able to drive?

* 7. Are there any conditions in which you would prefer not to drive (check all that apply)?

* 8. During the past 3 months, were you unable to travel to any of the following destinations because you did not have access to transportation (either your own car or a ride)?

* 9. Is transportation a major factor in whether or not you would schedule a medical appointment?

* 10. Which of the following statements about your local public transportation system are true for you (check all that apply)?

* 11. How would you prefer to schedule public or shared transportation?

* 12. Which zip code do you live in?

* 13. Do you or would you use public or shared transportation for reasons other than medical appointments? (check all that apply)

* 14. Are you eligible to receive SSI, Social Security Disability, MassHealth, SNAP, or other benefits with income guidelines?

* 15. Do you speak English as a second language (ESL)?

* 16. I am:

* 17. What is your race/ethnicity?

* 18. Including yourself, how many people live in your household?

* 19. What is your average annual household income?

* 20. Please list any suggestions to improve transportation services:

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