PICK MOD Survey

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* 1. WHERE DO YOU LIVE?

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* 2. PLEASE INDICATE YOUR AGE

16 - 19

20 - 29

30 - 59

60+

Prefer Not to Say

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* 3. PLEASE INDICATE YOUR GENDER

Male

Female

Transgender Male

Transgender Female

Prefer Not to Say

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* 4. PLEASE INDICATE YOUR RACE

Caucasian

African American

Native American

Hispanic/Latino

Other (please specify)

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* 5. EMPLOYMENT STATUS

Employed Full Time

Employed Part Time

Full Time Student

Part Time Student

Unemployed

Retired

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* 6. HOW OFTEN DO YOU USE PICK?

Once or Twice a Week

More than Three Times a Week

Once or Twice a Month

More than 3 Times a Month

I never use PICK

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* 7. WHAT ARE THE MAIN PURPOSES OF YOUR TRIPS?

Work

Education

Child Care

Medical

Groceries/Food

Religious Services

Recreation

Local Businesses/Shopping

Other (please specify)

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* 8. HOW DO YOU SCHEDULE YOUR PICK TRIP?

Uber App

Call Center

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* 9. WOULD YOU LIKE TO USE PICK DURING THE DAY INSTEAD OF YOUR REGULAR TRANSIT SERVICE?

Yes

Unsure

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* 10. HAS PICK IMPROVED YOUR QUALITY OF LIFE?

Yes

Unsure

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* 11. HOW DOES PICK SERVICES AFFECT YOUR FAMILY?

Positively

Negatively

No Change

Prefer not to answer

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* 12. PLEASE SELECT THE ANSWER THAT BEST DESCRIBES YOUR SATISFACTION WITH PICK IN EACH AREA:

	Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied
Ease of Getting Information	Ease of Getting Information Very Satisfied	Ease of Getting Information Satisfied	Ease of Getting Information Neutral	Ease of Getting Information Dissatisfied	Ease of Getting Information Very Dissatisfied
Ease of using the Uber App to Schedule a Ride	Ease of using the Uber App to Schedule a Ride Very Satisfied	Ease of using the Uber App to Schedule a Ride Satisfied	Ease of using the Uber App to Schedule a Ride Neutral	Ease of using the Uber App to Schedule a Ride Dissatisfied	Ease of using the Uber App to Schedule a Ride Very Dissatisfied
Ease of using the Call Center to Schedule a Ride	Ease of using the Call Center to Schedule a Ride Very Satisfied	Ease of using the Call Center to Schedule a Ride Satisfied	Ease of using the Call Center to Schedule a Ride Neutral	Ease of using the Call Center to Schedule a Ride Dissatisfied	Ease of using the Call Center to Schedule a Ride Very Dissatisfied
Courtesy of Driver	Courtesy of Driver Very Satisfied	Courtesy of Driver Satisfied	Courtesy of Driver Neutral	Courtesy of Driver Dissatisfied	Courtesy of Driver Very Dissatisfied
Cleanliness of Vehicles (inside and outside)	Cleanliness of Vehicles (inside and outside) Very Satisfied	Cleanliness of Vehicles (inside and outside) Satisfied	Cleanliness of Vehicles (inside and outside) Neutral	Cleanliness of Vehicles (inside and outside) Dissatisfied	Cleanliness of Vehicles (inside and outside) Very Dissatisfied
Sense of Personal Safety	Sense of Personal Safety Very Satisfied	Sense of Personal Safety Satisfied	Sense of Personal Safety Neutral	Sense of Personal Safety Dissatisfied	Sense of Personal Safety Very Dissatisfied
Vehicle On Time Performance	Vehicle On Time Performance Very Satisfied	Vehicle On Time Performance Satisfied	Vehicle On Time Performance Neutral	Vehicle On Time Performance Dissatisfied	Vehicle On Time Performance Very Dissatisfied
Comfort Level	Comfort Level Very Satisfied	Comfort Level Satisfied	Comfort Level Neutral	Comfort Level Dissatisfied	Comfort Level Very Dissatisfied
Service Hours Offered	Service Hours Offered Very Satisfied	Service Hours Offered Satisfied	Service Hours Offered Neutral	Service Hours Offered Dissatisfied	Service Hours Offered Very Dissatisfied

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* 13. DID YOU HAVE ANY BARRIERS THAT PREVENT YOU FROM ACCESSING PICK SERVICES?

Language (interpreter needed)

Physical Limitations

No/None

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* 14. HOW DID YOU LEARN ABOUT PICK?

Family/Friend

Social Media

Walk-In

Referred by other agency

Internet/Website

Newspaper/Radio/TV

Flyer/Brochure

Other (please specify)

PICK MOD Survey

Question Title

* 1. WHERE DO YOU LIVE?

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* 2. PLEASE INDICATE YOUR AGE

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* 3. PLEASE INDICATE YOUR GENDER

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* 4. PLEASE INDICATE YOUR RACE

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* 5. EMPLOYMENT STATUS

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* 6. HOW OFTEN DO YOU USE PICK?

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* 7. WHAT ARE THE MAIN PURPOSES OF YOUR TRIPS?

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* 8. HOW DO YOU SCHEDULE YOUR PICK TRIP?

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* 9. WOULD YOU LIKE TO USE PICK DURING THE DAY INSTEAD OF YOUR REGULAR TRANSIT SERVICE?

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* 10. HAS PICK IMPROVED YOUR QUALITY OF LIFE?

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* 11. HOW DOES PICK SERVICES AFFECT YOUR FAMILY?

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* 12. PLEASE SELECT THE ANSWER THAT BEST DESCRIBES YOUR SATISFACTION WITH PICK IN EACH AREA:

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* 13. DID YOU HAVE ANY BARRIERS THAT PREVENT YOU FROM ACCESSING PICK SERVICES?

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* 14. HOW DID YOU LEARN ABOUT PICK?

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* 15. DO YOU HAVE ANY SUGGESTIONS HOW WE COULD IMPROVE THE SERVICES WE PROVIDED TO YOU?