Personal Mobility Study Survey

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* 1. Contact Information

Name

City/Town

Country

LinkedIn/Social Media Link

Email Address

Phone Number

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* 2. How old are you?

19 or younger

20-30

31-40

41-50

51-60

61-65

65 or older

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* 3. What gender do you identify with?

Female

Male

Other (please specify)

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* 4. What is your annual income?

Under €20,000

€20,000 to €39,999

€40,000 to €59,999

€60,000 to €79,999

€80,000 to €99,999

€100,000 to €124,999

€125,000 or more

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* 5. In general, how often do you travel using the following?

	Daily	Weekly	Monthly	Less than monthly	Never
Walking	Walking Daily	Walking Weekly	Walking Monthly	Walking Less than monthly	Walking Never
Mobility Scooter	Mobility Scooter Daily	Mobility Scooter Weekly	Mobility Scooter Monthly	Mobility Scooter Less than monthly	Mobility Scooter Never
Carpool	Carpool Daily	Carpool Weekly	Carpool Monthly	Carpool Less than monthly	Carpool Never
Public Transit	Public Transit Daily	Public Transit Weekly	Public Transit Monthly	Public Transit Less than monthly	Public Transit Never
RideShare/Taxi	RideShare/Taxi Daily	RideShare/Taxi Weekly	RideShare/Taxi Monthly	RideShare/Taxi Less than monthly	RideShare/Taxi Never
Car Share	Car Share Daily	Car Share Weekly	Car Share Monthly	Car Share Less than monthly	Car Share Never
Driving my own car	Driving my own car Daily	Driving my own car Weekly	Driving my own car Monthly	Driving my own car Less than monthly	Driving my own car Never

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* 6. Are you thinking about getting a mobility scooter in the next few months/ years?

Yes

Unsure

I already own one

Other (please specify)

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* 7. Do you have a long-standing physical or mental impairment, illness or disability affecting any of the following areas?

Mobility (e.g. difficulty walking long distances or climbing stairs)

Vision (e.g. blindness or partial sight)

Hearing (e.g. deafness or partial hearing)

Dexterity (e.g. difficulty lifting objects and using buttons)

Learning, understanding or concentrating

Memory

Mental health

Stamina, breathing or fatigue

None of the above

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* 8. How often do you use your mobility scooter?

Every day

Most days

Once a week

A few times a month

Monthly

Less than once a month

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* 9. How long ago did you start using a mobility scooter?

Under 6 months ago

6 months to 2 years ago

More than 2 years ago

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* 10. For what purpose do you usually use a mobility scooter? (Select all that apply)

Go to/from work

Go to/from school

Errands/Appointments

Dining/shopping

Exercise/recreation

Get to /from transit stop

Sightseeing

Other (please specify)

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* 11. Where do you normally use a scooter? (select all that apply)

Inside my home

Inside other buildings (eg shops)

On pavements

On roads

In parks or countryside

Other (please specify)

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* 12. When choosing your scooter, which of the things below were most important?

	Very important	Some Importance	Not Important	N/A
Easy to store	Easy to store Very important	Easy to store Some Importance	Easy to store Not Important	Easy to store N/A
Comfort	Comfort Very important	Comfort Some Importance	Comfort Not Important	Comfort N/A
Range	Range Very important	Range Some Importance	Range Not Important	Range N/A
Design/appearance	Design/appearance Very important	Design/appearance Some Importance	Design/appearance Not Important	Design/appearance N/A
Price	Price Very important	Price Some Importance	Price Not Important	Price N/A
Easy to lift/carry	Easy to lift/carry Very important	Easy to lift/carry Some Importance	Easy to lift/carry Not Important	Easy to lift/carry N/A
Can use on road	Can use on road Very important	Can use on road Some Importance	Can use on road Not Important	Can use on road N/A
Can take on public transport	Can take on public transport Very important	Can take on public transport Some Importance	Can take on public transport Not Important	Can take on public transport N/A
Can fit in car boot	Can fit in car boot Very important	Can fit in car boot Some Importance	Can fit in car boot Not Important	Can fit in car boot N/A
Reliability	Reliability Very important	Reliability Some Importance	Reliability Not Important	Reliability N/A
Safety	Safety Very important	Safety Some Importance	Safety Not Important	Safety N/A

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* 13. How much more are you willing to invest in your scooter if it had improved safety?

Between €100 to €500

Between €500 to €1000

More than €1000

Not Relevant

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* 14. In your own words what are the top 3 features that you wish to have on your mobility scooter?

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* 15. What is the brand name of your scooter?

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* 16. Which of these types of scooter do you own?

Outdoor mobility scooter (medium / big size)

Indoor mobility scooter

Heavy duty

Recreational scooter

Other (please specify)

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* 17. What is the size of the scooter you own?

Small / folding

Mid-size

Big size

Other (please specify)

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* 18. Where did you get your mobility scooter from?

From a shop

Online

From a print advert

From a friend/acquaintance

Other (please specify)

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* 19. If you own your scooter, how did you pay for it?

Local authority assessment

Charitable source

Privately funded (i.e. bought)

Other (please specify)

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* 20. How likely are you to buy a new mobility scooter in the next 12 months?

Extremely likely

Very likely

Somewhat likely

Not so likely

Not at all likely

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* 1. Contact Information

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* 2. How old are you?

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* 3. What gender do you identify with?

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* 4. What is your annual income?

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* 5. In general, how often do you travel using the following?

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* 6. Are you thinking about getting a mobility scooter in the next few months/ years?

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* 7. Do you have a long-standing physical or mental impairment, illness or disability affecting any of the following areas?

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* 8. How often do you use your mobility scooter?

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* 9. How long ago did you start using a mobility scooter?

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* 10. For what purpose do you usually use a mobility scooter? (Select all that apply)

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* 11. Where do you normally use a scooter? (select all that apply)

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* 12. When choosing your scooter, which of the things below were most important?

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* 13. How much more are you willing to invest in your scooter if it had improved safety?

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* 14. In your own words what are the top 3 features that you wish to have on your mobility scooter?

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* 15. What is the brand name of your scooter?

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* 16. Which of these types of scooter do you own?

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* 17. What is the size of the scooter you own?

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* 18. Where did you get your mobility scooter from?

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* 19. If you own your scooter, how did you pay for it?

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* 20. How likely are you to buy a new mobility scooter in the next 12 months?

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* 21. How much did you spend on your scooter/ how much are you willing to spend?