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Public Transportation Survey
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* Indicates required question
Email
*
Your email
Do you currently use public transportation?
*
Choose
Yes
No
If "Yes", How often do you use public transportation
*
1-2 Times per week
3-4 Times per week
5-6 Times per week
7 or more times per week
I do not use public transportation
Which of the following are your most commonly visited destinations or places you most often need to visit when transportation is available to you?
(Select all that apply)
*
Employer (Transportation to and from work)
Medical/Dental appointments
Shopping/Grocery
School
Senior Citizen programs or human service agency activities
Church/Faith-Based organizations and activities
Social/Recreational activities/Parks
Other:
Required
Are you or a family member currently using any transportation services that are available to you through the Medicaid program?
*
Yes
No
What County do live in?
*
Highland
Adams
Brown
Other:
How often are you unable to get to where you need to go because of not having a way to get there?
Rarely
About once a month
More than once a month
Several times per year
Once a week or more
Clear selection
What age demographic applies to you?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Clear selection
Which of the following would best describe you fare type usage?
Private Insurance Pay
General Pay (Single Ride $1, $2, $3, $4-inter county)
30-Day Pass
Other:
Clear selection
What type of trips would you like to take that your transportation provider does not offer?
(Check all that apply)
Long Distance (Out of you county of residence)
Multi-stop trips (multiple places within the same trip)
Weekends
Education or Training
Essential non-medical (bank, post office, shopping)
Childcare
Social Services
Other:
How would you rate Public Transportation as it is today?
Excellent
Good
Fair
Poor
Clear selection
Submit
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