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53 <br /> IV. Let's talk about transportation... <br /> 17) Do you Imve your own transportation? ❑ Yes ❑ No <br /> 18) Is transportation a problem for you? ❑ Yes ❑ No <br /> If yes,what is the problem? <br /> ❑ Too expensive ❑ Hard to get to public transportation <br /> ❑ Reliability of Own Vehicle ❑ Other <br /> 19) How do you get around? <br /> ❑ Taxi ❑ Friends ❑ Walk 0 Bicycle <br /> ❑ Own car ❑ Family ❑ Bus system/Public Transportation <br /> 0 Other <br /> V. Let's talk about health services... <br /> 20) Where do you go when you or your children are sick or need health care? <br /> 0 Private Physician ❑ Health Department Clinic ❑ Hospital <br /> ❑ Emergency Room ❑ Prospect Hill Clinic ❑ Piedmont Health Clinic <br /> ❑ Other <br /> 21) Does your family have: ❑ Health insurance <br /> ❑ SSI (Supplemental Security Income) <br /> ❑ Self-paid <br /> ❑ Medicaid <br /> ❑ Other <br /> 22) What would make health care services easier for you to use? <br /> 0 More convenient location 0 More hours of availability <br /> ❑ Less cost 0 Other <br /> VI. Let's talk about recreation... <br /> 23) How ft do you have to travel to get to a recreation facility? <br /> ❑ Less than a mile ❑ 2-5 miles ❑ more than 5 miles <br /> 24) What type of recreation facility do you use? <br /> ❑ community centers ❑ gyms ❑ athletic fields 0 senior centers <br /> 0 parks other <br /> 25) Are these facilities age appropriate and safe? <br /> ❑ Yes ❑ No <br />