Disabilitygas.com - Take Our Survey

1. What is your gender?

Male

Female

2. What is your age?

3. Which state do you live in?

4. What is your disability?

5. How often do you drive?

7. Approximately how many miles do you drive each week on average?

8. Are you able to pump your own gas at service stations or do you require assistance?

Can pump my own

Require assistance

Can pump my own but prefer having assistance

9. Is the Department of Justice doing enough to enforce the refueling policy?

Yes

No

10. What is your primary reason for driving?

Getting to/from work

Errands/personal reasons

Travel/leisure

Other (please specify):

11. Are you aware of the refueling assistance policy set forth by the US Department of Justice?

Yes

No

12. (If you answered yes to question 11) How would you rate the awareness among service station attendants of the current refueling policy?

13. (If you answered yes to question 11) How would you rate the attitude of service station attendants towards providing refueling assistance?

14. How often do you know when there is more than one employee on duty at a gas station?

Always

Sometimes

Never

15. What arrangements do you make to ensure that you will have refueling assistance?

Bring a friend/family member with me to pump gas

Ask another customer for fueling assistance

Honk my horn to get the attention of an attendant

Have someone take my car to the station and refuel it

Go to a station where they know me and will always provide assistance

I don't make special arrangements

16. What is your main concern when going to an unfamiliar service station by yourself?

Your personal safety

Giving your credit card to a stranger to pay for the gas purchase

Not being able to get assistance

Other (please specify):

17. Have you ever put off driving/travel plans, by yourself, because of concerns about your ability to get refueling assistance?

Yes

No

18. Is there a particular brand or company that is doing a favorable job in accommodating drivers with disabilities?
Or, is there a brand or company NOT doing a favorable job? If so, please explain.

19. If you have a particular anecdote or story about refueling challenges that you have faced, please give a brief explanation below of the circumstances and how it was resolved.

20. In your mind, who is the most effective legislator either on a federal, state or local level to get legislation passed?

21. What is the most progressive/effective disability organization to assist in getting this legislation passed?

22. Please keep me informed of developments on the issue of refueling assistance.

Yes

No

I would be interested in participating in advocacy efforts by:

Writing/calling my legislators

Meeting with my legislators

Enlisting the support of others in my community