Connect to Health @ Your Library

1. Which library are you using to access the equipment/space?

2. What did you use the equipment/space for?

Health-related appointment
Mental/behavioral health appointment
Education
Legal appointment
Job interview
Job training or career coaching
Other - Write In Please enter an 'other' value for this selection.

3. Why are you using the equipment/space versus doing this at home?

I don't have internet at home
My internet doesn't work well enough at home
I don't have a computer at home
I needed a private space for my appointment/service
I need help with technology or using the devices to connect for my appointment/service
I was referred by my health provider
Other - Write In Please enter an 'other' value for this selection.

4. Did using the equipment/space save you miles and/or time that you otherwise would have spent traveling to get to the appointment/service?

5. How many miles did you save?

5. How much time did you save?

5. Did all of the equipment work as you expected?

6. More information:

6. If this equipment/space were not available to you, would you have been able to connect to the service you used?

7. If this equipment/space were not available to you, what arrangements would you have had to make in order to make your appointment or receive the service?

Travel for a long time to get services in person
Arrange child or elder care and/or take children or an elder with me to the appointment/service
Take time off work
Ask a loved on to drive me and/or take off work to accompany me to my appointment/service
Borrow a computer/device to connect to my appointment/service
Use another public space and/or a loved one's home to have my appointment/service
I would not have been able to receive the service at all
Other - Write In Please enter an 'other' value for this selection.
Not applicable - I would not have had to make any arrangements

8. Rate how satisfied/happy you are with the equipment/space.

Very dissatisfied/very unhappy	Dissatisfied/Unhappy	Neutral	Satisfied/Happy	Very satisfied/Very happy
Very dissatisfied/very unhappy	Dissatisfied/Unhappy	Neutral	Satisfied/Happy	Very satisfied/Very happy

9. Why did you give the equipment/space this rating?

9. Would you use the equipment/space again?

10. If no, why not?

10. Is there anything else you'd like to share? We're looking for any feedback or stories that would help us demonstrate the value of the equipment/space to expand this project across Colorado.