Mobility Question Title * 1. What county do you live in? Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson De Kalb Decatur Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth OK Question Title * 2. Do you currently use public transportation, paratransit, fixed routes, demand responsive, or all? Paratransit Fixed routes Demand Responsive All of the above OK Question Title * 3. How often do you need/ use transportation for medical appointments? 1-3 times a week 4-7 times a week Once a month More than 5 times a month OK Question Title * 4. How often do you need/ use transportation for activities of daily living 1-3 times a week 4-7 times a week Once a month More than 5 times a month OK Question Title * 5. What forms of mobility aids do you use? Walk Wheelchair Scooter Walker Crutches Cane Service dog OK Question Title * 6. What current barriers hinder your mobility? (check all that apply) Cost Access Availability Other (please specify) OK Question Title * 7. If offered, would use private transportation options like Uber or Lyft? Yes No OK Question Title * 8. Which hours between 6 A.M. and 6 P.M. would you need access to transportation during the week including weekends? Weekdays 6A.M.-9A.M. Weekdays 9A.M.-12 P.M. Weekdays 12P.M.-3 P.M. Weekdays 3 P.M.-6P.M. Weekends 6A.M.-9A.M. Weekends 9A.M.-12 P.M. Weekends 12P.M.-3 P.M. Weekends 3 P.M.-6P.M. Both Weekdays & Weekends 6A.M.-9A.M. Both Weekdays & Weekends 9A.M.-12 P.M. Both Weekdays & Weekends 12P.M.-3 P.M. Both Weekdays & Weekends 3 P.M.-6P.M. OK DONE