MH/DS Transportation Survey


This brief survey is being conducted by transportation providers and the department of Mental Health and Disability Services (MHDS) East Central Region as a way to understand transportation needs and challenges in our area. Your input is very valuable to us.  This survey will close on October 16th. If you have questions about the survey or need assistance please contact Mike Barnhart or Nick D'Amico at 319-398-3943.  Thank you!”

What is your name? ( optional)

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* 1. What is your name? ( optional)

What is your street address?

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* 2. What is your street address?

In what city do you live?

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* 3. In what city do you live?

In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 52403 or 52057)

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* 4. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 52403 or 52057)

What is your age?

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* 5. What is your age?

Do you receive disability services?

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* 6. Do you receive disability services?

Do you receive elderly services?

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* 7. Do you receive elderly services?

How are your transportation expenses currently being paid for?

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* 8. How are your transportation expenses currently being paid for?

How do you usually get rides when you need them? ( check all that apply)

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* 9. How do you usually get rides when you need them? ( check all that apply)

Do you have difficulty finding transportation to any of the following (check all that apply)?

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* 10. Do you have difficulty finding transportation to any of the following (check all that apply)?

If yes, where is the destination located that you are having a difficult time getting to? (if possible, please list specific locations or addresses)

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* 11. If yes, where is the destination located that you are having a difficult time getting to? (if possible, please list specific locations or addresses)

Do you have a disability that requires use of an ADA accessible vehicle?

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* 12. Do you have a disability that requires use of an ADA accessible vehicle?

What barriers keep you from using existing transportation services in your area? (check all that apply)

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* 13. What barriers keep you from using existing transportation services in your area? (check all that apply)

How often do you need transportation?

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* 14. How often do you need transportation?

What days are most difficult for you to get where you need to go?

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* 15. What days are most difficult for you to get where you need to go?

What times are most difficult for you to get where you need to go?

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* 16. What times are most difficult for you to get where you need to go?

How long do your current rides usually take?

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* 17. How long do your current rides usually take?

What do you consider an acceptable time to wait for your ride?

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* 18. What do you consider an acceptable time to wait for your ride?

Are your transportation providers consistently on-time and reliable?

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* 19. Are your transportation providers consistently on-time and reliable?

Do you feel safe with the transportation providers you use?

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* 20. Do you feel safe with the transportation providers you use?

Do you feel respected by the transportation providers you use?

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* 21. Do you feel respected by the transportation providers you use?

Are you employed

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* 22. Are you employed

If yes: Where do you work?

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* 23. If yes: Where do you work?

How do you currently get to work? ( check all that apply)

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* 24. How do you currently get to work? ( check all that apply)

Have you ever had difficulty getting a job due to lack of transportation?

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* 25. Have you ever had difficulty getting a job due to lack of transportation?

Have you ever lost a job due to lack of transportation?

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* 26. Have you ever lost a job due to lack of transportation?

If available would you utilize a transportation service with volunteer drivers?

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* 27. If available would you utilize a transportation service with volunteer drivers?

Do you have any suggestions to improve transportation in your area?

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* 28. Do you have any suggestions to improve transportation in your area?

Most working people have to budget a certain amount of their income each month for transportation. If you are working, how much do you feel you are able to pay for a ride?

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* 29. Most working people have to budget a certain amount of their income each month for transportation. If you are working, how much do you feel you are able to pay for a ride?

Thank you for taking the time to complete this survey!
The information you've provided will be helpful with efforts to improve transportation services in Eastern Iowa!

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