Rural Transportation Needs Survey

Question Title

* 1. Please select your age

Question Title

* 2. Select which COUNTY you live in.

Question Title

* 3. What City/Town do you live in (or what is the nearest city or town to your home)?

Question Title

* 4. What best describes the person completing this survey?

Question Title

* 5. Mark ALL types of transportation you have used the past 12 months. Check all that apply

Question Title

* 6. If transportation was easy to use and available to you and/or your family, which of the following would cause you to use the services? (please select all that apply)

Question Title

* 7. What would make local transportation options more appealing to you? Check all that apply

Question Title

* 8. Where do you travel to the most? Check all that apply

Question Title

* 9. How far are the places that you most often need to go?  Check all that apply

Question Title

* 10. What times do you most often need transportation? Check all that apply

Question Title

* 11. What days of the week are you do need/want to travel? (select all that apply)

Question Title

* 12. Do you have difficulty getting transportation outside of your County?

Question Title

* 13. Do you have a disability which requires you to use a cane, walker, wheelchair, and/or another device to help you get around?  

Question Title

* 14. Are you or a family member currently using any transportation services that are available to you through the Medicaid program? 

Question Title

* 15. What makes using a transportation service most difficult?

Question Title

* 16. What is important to you when using a transportation service?

Question Title

* 17. What would you like to see in your community that would help you get around better?

Question Title

* 18. How well do current transportation options meet you expectations?

Question Title

* 19. What improvements to transportation would you like to see in your community?

T