Survey

What motivated you to sign up for GoGo’s services? Select all that apply.

I need a ride to/from the airportI need a ride to/from the hospitalMy car is in the shopMy car broke downI lost my driver’s licenseVision or mobility issues make driving hardFriends or family can’t drive me anymoreI have regular medical appointmentsI’m recovering from injury or surgeryNew medication affects my ability to driveI prefer not to drive in bad weather

Other

Please select one or more of the following groups which you consider yourself a member

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoMiddle Eastern or North AfricanNative Hawaiian or other Pacific IslanderSouthwest Asian and North AfricanWhiteNone of the aboveDecline to state

Are you a veteran?

Yesno

Do you have a special healthcare need, physical disability, or mental health condition that limits your ability to take care of your daily needs?

Yesno

What was your sex assigned at birth?

MaleFemaleDecline to State

What is the name of your health insurance provider?

What type of health insurance do you currently have?

MedicareMedicare AdvantageMedicare SupplementalMedicaid (Medi-Cal)VA BenefitsEmployer benefitsPrivate payDecline to stateIn between plans / not insured

Other

GoGoGrandparent Survey

Thanks for registering.
Answer these questions to see if GoGo is reimbursable for you!

GoGoGrandparent Survey

Thanks for registering. Answer these questions to see if GoGo is reimbursable for you!

Thanks for registering.
Answer these questions to see if GoGo is reimbursable for you!