Purple Path: The Epilepsy Mobility Initiative
Help us understand how a ride share program could assist patients with epilepsy in attending appointments. Your feedback is valuable to improve transportation services. Safe, reliable transportation for people living with epilepsy. Our mission is to eliminate transportation barriers for individuals at risk of seizures, ensuring they can access medical care, employment, and community life without fear or limitation.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have epilepsy?
*
Yes
No
If yes, what type of epilepsy do you have?
Are you a patient at Barrows Neurological Institute?
*
Yes
No
If not, where do you attend for you neurological appointments?
What accommodations would help make transportation easier for you? (Select all that apply)
Priority scheduling
Door-to-door service
Assistance during transit
Accessible vehicle options
Companion support
Other (please specify)
If you selected 'Other', please specify:
Do you have a support animal?
Yes
No
Would a trained driver, prepared to help with seizures make you more comfortable?
Yes
No
Not sure
Would you prefer if the driver check the vehicle upon your exit to see if you forgot any items?
Yes, I do often forget things
No
Are there any other accommodations that would prefer to make your ride safer to your appointments?
Submit
Should be Empty: