Do you have the ability to use the fixed-route bus system in the Omnitrans service area?
Yes, I can always use it.
Yes, I can sometimes use it.
No, I can never use it.
Do you own a smartphone?
Yes, I do own a smartphone.
No, I do not own a smartphone.
I live...
Alone.
With my spouse.
With other family members.
With friends.
With a paid caregiver.
In a skilled nursing facility.
In an assisted living facility.
Other
For mobility, I currently use...
A foldable walker.
A non-foldable walker.
A foldable wheelchair.
A non-foldable wheelchair.
A power scooter.
An electric wheelchair.
Crutches.
Braces.
Prosthetics.
A certified service animal.
A cane.
Other
None of these.
Are you a senior (age 62 plus)?
Yes, I am a senior.
No, I am not a senior.
Are your health conditions verified by a doctor?
Yes, they have been verified by a doctor.
No, they have not been verified by a doctor.
Have you ever served in the military?
Yes, I have served in the military.
No, I have not served in the military.
Are you able to drive a vehicle owned by you?
I don’t own a vehicle.
Yes, I am able to drive a vehicle owned by me.
No, I am not able to drive a vehicle owned by me.
Are you already registered with any other transportation services/ADA paratransit services (such as Access)?
Yes, I am.
No, I am not.
Do you know someone who can be your potential driver?
Yes, I know who can be my potential driver.
No, I do not have any potential drivers.
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