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

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

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

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

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

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

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

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

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

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

Are you currently able to drive?

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* 6. Are you currently able to drive?

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

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

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)?

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* 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)?

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

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

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

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

How would you prefer to schedule public or shared transportation?

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

Which zip code do you live in?

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* 12. Which zip code do you live in?

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

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

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

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

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

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

I am:

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* 16. I am:

What is your race/ethnicity?

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* 17. What is your race/ethnicity?

Including yourself, how many people live in your household?

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

What is your average annual household income?

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* 19. What is your average annual household income?

Please list any suggestions to improve transportation services:

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

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