Crosslake Cares Senior Transportation survey

Greetings,
We at Crosslake Cares are striving to improve transportation options for the Seniors in our community. To better understand the needs of our senior residents, we are asking you to complete the enclosed survey as honestly and completely as possible.

Your responses will be used solely for the purpose of gathering information pertinent to our
research regarding transportation needs and will not be distributed or shared elsewhere.

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* 1. What is your age?

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* 2. What is your zip code?

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* 3. Are you currently able to drive?

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* 4. If you depend on others for transportation, on whom do you depend? (Check all that apply)

Spouse

Children/other relatives

Friends or neighbors

Medical Transportation Services (i.e. Medivan)

Volunteers from church or non-profits like Interfaith Volunteers

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* 5. Within the last 3 months, how much did you rely on others for transportation

For all of my trips

For about 75% of my trips

For about 50% of my trips

For about 25% of my trips

For non of my trips

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* 6. If you do drive, to which local destinations do you drive? (check all that apply)

Shopping, grocery store, bank etc.

Medical/dental appointments

Social outings (friend or relatives home, dining out, golf, etc.)

Religious services

School/education or exercise classes/gym

Work or volunteer activities

Other

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* 7. Are there any circumstances in which you would prefer NOT to drive? (check all that apply)

After dark

More than 3 miles from your home

To the doctor when I am ill

To unfamiliar areas

Other

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* 8. Within the last 3 months, which of the following factors prevented you from making trips away from home? (Check all that apply)

Unable or uncomfortable driving

Do not have a reliable vehicle

Have no one to drive me

Unaware of transportation options in the area

Do not feel safe traveling outside my home

Have no one to call for help

Other

Crosslake Cares Senior Transportation survey

Question Title

* 1. What is your age?

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* 2. What is your zip code?

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* 3. Are you currently able to drive?

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* 4. If you depend on others for transportation, on whom do you depend? (Check all that apply)

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* 5. Within the last 3 months, how much did you rely on others for transportation

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* 6. If you do drive, to which local destinations do you drive? (check all that apply)

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* 7. Are there any circumstances in which you would prefer NOT to drive? (check all that apply)

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* 8. Within the last 3 months, which of the following factors prevented you from making trips away from home? (Check all that apply)

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* 9. Comments