This survey is being done to gather information on the ability of Medicare beneficiaries to get timely repairs to their wheelchairs. The results will be shared with Medicare officials and policymakers. Thank you for your participation!
The questions with asterisks are required and the survey cannot be completed without responding to those questions.

* 1. Please provide the following information:

* 2. Please tell us where you live:

* 3. Which age group are you?

* 4. Please describe your condition/disability:

* 5. What type of insurance do you have?

* 6. What type of wheelchair do you use?

* 7. How many years have you used a wheelchair?