On-Demand Service Eligibility Assessment Form
Please complete the On-Demand Service Eligibility Assessment Form to help us determine your eligibility for our on-demand service. All questions are required for a thorough assessment.
What type of on-demand service are you requesting?
*
Please Select
Delivery
Transportation
Home Services
Personal Assistance
Other
How urgent is your service need?
*
Immediate (within 1 hour)
Today
This week
Flexible
Have you previously used any on-demand services?
*
Yes
No
If yes, which providers have you used before? (Select all that apply)
Uber
DoorDash
TaskRabbit
Instacart
Other
Please rate your overall satisfaction with on-demand services you have used in the past.
*
1
2
3
4
5
How likely are you to recommend on-demand services to others?
*
Not likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not likely, 10 is Extremely likely
Please indicate your level of agreement with the following statements.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I have reliable access to the internet or a smartphone.
1
2
3
4
5
I am comfortable using mobile apps.
6
7
8
9
10
I understand the terms and conditions of most on-demand services.
11
12
13
14
15
What is your primary reason for requesting this on-demand service?
*
Please Select
Convenience
Urgency
Lack of alternatives
Recommendation
Other
Briefly describe your current situation or need for the on-demand service.
*
Please provide your email address so we can send you the eligibility results.
*
example@example.com
Submit Assessment
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