Do you put off or neglect going to the doctor because of distance or transportation?
Yes/No
In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?
Yes/ No
How often has lack of transportation
kept you from medical appointments,
meetings, work, or from getting things
needed for daily living?
Often
Sometimes
Never
Do you need assistance with
transportation for an upcoming
appointment?
Yes
No
Within the past 12 months, has lack of transportation kept you from medical appointments, getting your medicines, non-medical meetings or appointments, work, or from getting things that you need?
Yes/ No
Do you have trouble getting transportation to medical appointments?
Yes/ No
How often is it difficult to get transportation to or from your medical or follow-up appointments?
Does not apply
Never
Sometimes
Often
Always
In the last 12 months, have you ever had to go without health care because you didn’t have a way to get there?
Yes/No
Within the past 12 months, has a lack of transportation kept you from medical appointments or from doing things needed for daily living?
Yes/ No
Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? Check all that apply.
Yes, it has kept me from medical appointments or from getting my medications
Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need
No
I choose not to answer this question
Do you have trouble finding or paying for a ride?
In the past 3 months, did you have trouble paying for any of the following? (Select ALL that apply)
Transportation
Has lack of transportation kept you from medical appointments or from doing things needed for daily living? (Select ALL that apply)
Kept me from medical appointments or from getting medications
Kept me from doing things needed for daily living
Not a problem for me
University of San Francisco California