Membership

MSCPVA Transportation Needs Survey

Dear Members of the Mountain States Chapter of Paralyzed Veterans of America (MSCPVA):

We are seeking information about your transportation needs. Please take a moment to complete the following short survey. The survey will take approximately five minutes to complete. Thank you for your participation and helping us improve our services.

Please provide your name and contact information below.
Name
Telephone Number
Email Address
Please check the circle next to the best answer for the following questions.
Approximately how many appointments (including medical, dental etc.) do you travel to during an average month?
1-2
3-4
5-6
6 or more
How do you get to your appointments?
I have my own van.
My spouse or caregiver.
I use a taxi or professional service.
  What service:
Other:
How often during the last year have you had to cancel an appointment because you didn't have transportation?
1-2 Times
3-4 Times
5-6 Times
None
Would you benefit from additional transportation services?
Yes
No
Occasionally
Please describe the type of assistance that would be most beneficial to you.
(i.e., my own van, an occasional ride to an appointment etc.)
Thank you for taking the time to complete this survey! For any questions regarding this survey, please contact the chapter office at 1-800-833-9400 or info@mscvpa.org


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CHAPTER CONTACT:
12200 East Iliff Avenue
Suite 107
Aurora, CO 80014
303-597-0038
1-800-833-9400
Fax: 303-597-0039
Email: info@mscpva.org
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Paralyzed Veterans of America      Chartered by the Congress of the United States