Wheels for Wellness Ride Checklist

Please fill out the below questionnaire. All questions with a red star are required.

1Information

2Driver Info

3Questions

4Questions

Thank you for completing this ride! Please fill out the below questionnaire. All questions with a red star are required.

Driver Name *

First

Last

Client Name *

First

Last

Date of Ride *

Pick Up Time *

Home Drop Off Time *

Feedback Notes *

Did you wear a mask on this trip? *Please note that masks are mandatory at this time* *

Did the client wear a mask on this trip? *Please note that masks are mandatory at this time* (copy) *

Did you sanitize your vehicle prior to ride? *

Was the client ready when you arrived? *

Did the client need excessive assistance when entering or exiting the vehicle? *

Was ride completed within time frame of request? *

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