Metrolina Association for the Blind's Community Needs Survey

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* 3. What is your total household income?

$0- $19,999

$20,000- $39,999

$40,000- $79,999

$80,000-$149,999

$150,000 or more

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* 4. Please enter your zip code.

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* 5. What level is your visual impairment?

Mild or no visual impairment

Moderate visual impairment

Severe visual impairment

Blindness, both eyes

Not sure

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* 6. Do you have hearing loss?

I have diagnosed hearing loss and wear hearing aids

I have diagnosed hearing loss but do not wear hearing aids

I have suspected hearing loss

I don't have hearing loss

Not sure

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* 7. Do you manage your own medications ?

I am able to manage my medications with no help

I need assistance managing my medications because of my vision loss

I need assistance managing my medication for other reasons

I do not currently take any medications

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* 8. Are you able to manage your healthcare needs ( keep track of your health information : medical conditions, records, etc.) ?

I am able to manage my healthcare needs with no help

I need assistance managing my healthcare because of my vision loss

I need assistance managing my healthcare for other reasons

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* 9. Have you had a primary care doctor appointment in the last year?

I have had a primary care appointment in the last year in person

I have had a primary care appointment in the last year using virtual care (telehealth)

I have not had a primary care appointment in the last year

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* 10. Do you use a cell phone?

Yes, I access it using assistive technology like VoiceOver or Zoom

Yes, I access it without using assistive technology

Yes, but I can't access it reliably

No, I do not currently use a cell phone

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* 11. Do you use a computer ?

Yes, I use a computer and access using assistive technology like a magnifier or screen reader

Yes, I use a computer and reliably access it without assistive technology

Yes, I use a computer but cannot reliably access it. I currently own assistive technology like a screen reader or magnifier.

Yes, I use a computer but cannot reliably access it. I currently do not own assistive technology like a screen reader or magnifier.

No, I do not currently use a computer

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* 12. Do you stay current with the technology available for individuals with vision loss? (select all that apply)

I seek out as much information as possible regarding the technology available to me

I talk with my friends, professionals and others to find out what the latest technology available is to me

I don't engage with technology because I don't think I will be able to use it

I don't engage with technology because I can't afford it

I don't engage with technology because I don't understand what I can do with it

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* 13. Are you independently able to pick out clothes ?

Yes, I pick out my own clothes

No, I need assistance picking and matching clothes because of my vision loss

No, I need assistance picking and matching clothes for other reasons

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* 14. Are you able to prepare a meal for yourself ?

Yes, I can prepare a meal for myself

No, I need my meals prepared for me because of my vision loss

No, I need my meals prepared for me for other reasons

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* 15. Do you manage your own finances?

Yes, I manage my own finances

No, I can't manage my finances because of my vision loss

No, I can't manage my finances for other reasons

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* 16. What source do you use for transportation ? (select all that apply)

I drive

I use public transportation (i.e. the bus)

I use special transportation (i.e. STS, MTS or VA )

I ask family and friends for transportation

I use rideshare/pay services (i.e. Lyft, Uber or taxi)

Other (please specify)

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* 17. Has your mental health been impacted by your vision loss?

Yes, I have sought or am currently seeing a mental health professional

Yes, but I have not sought professional help

Initially, but I now feel I have the tools to cope with my vision loss

No, my mental health has not been impacted by my vision loss

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* 18. Do you currently engage in meaningful avocational activities (hobbies) ?

Yes, I am engaged in activities that bring me joy

No, I gave up these activities because of my vision loss

No, I gave up these activities for other reasons

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* 19. What hobbies are you aware of that are available to individuals with vision loss?

Golf

Bowling

Kayaking

Knitting/ sewing

Music

Reading

Swimming

Tandem biking

Running

Yoga/ Tai Chi

Art /crafts

Other (please specify)

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* 20. What is your preferred method of communication (select all that apply)?

Telephone

US mail

Text

Other (please specify)

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* 21. Are you able to read Braille?

Yes, I am a proficient Braille reader

Yes, but I could use some additional training

No, I do not read Braille

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* 22. Are you currently or have you previously received services from Metrolina Association for the Blind?

Yes, I am a current or former client of MAB

No, I have not been a client of MAB

No, I have not been a client of MAB but received services elsewhere

I don't know

Metrolina Association for the Blind's Community Needs Survey

Help us improve services!

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* 1. What is your gender?

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* 2. What is your age?

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* 3. What is your total household income?

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* 4. Please enter your zip code.

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* 5. What level is your visual impairment?

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* 6. Do you have hearing loss?

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* 7. Do you manage your own medications ?

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* 8. Are you able to manage your healthcare needs ( keep track of your health information : medical conditions, records, etc.) ?

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* 9. Have you had a primary care doctor appointment in the last year?

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* 10. Do you use a cell phone?

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* 11. Do you use a computer ?

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* 12. Do you stay current with the technology available for individuals with vision loss? (select all that apply)

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* 13. Are you independently able to pick out clothes ?

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* 14. Are you able to prepare a meal for yourself ?

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* 15. Do you manage your own finances?

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* 16. What source do you use for transportation ? (select all that apply)

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* 17. Has your mental health been impacted by your vision loss?

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* 18. Do you currently engage in meaningful avocational activities (hobbies) ?

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* 19. What hobbies are you aware of that are available to individuals with vision loss?

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* 20. What is your preferred method of communication (select all that apply)?

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* 21. Are you able to read Braille?

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* 22. Are you currently or have you previously received services from Metrolina Association for the Blind?

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* 23. How did you hear about the survey?

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* 24. Would you like to receive communication from MAB? Please leave us your email.

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* 25. Is there anything else you would like us to know?