How about this?

Q1: Which disability or health related conditions PREVENT you from using regular public transit without the help of another person(i.e. BART, bus, streetcar)?
Cataract
General weakness
Poor memory

 Q2: Briefly explain HOW your condition prevents you from using regular public transit without the help of another person.
My vision is poor with cataract and I cannot see the stop names clearly.
My legs are weak and I have to use a walker. Still, I have to stop and rest after about half a block.
My memory is failing and I cannot remember which stations to get off. I need to transfer to get to some doctors' clinics.

Q3: Which of the following statements best describes you if you had to wait outside for a ride?
(Check only one response):
X  I would need someone to wait with me because  ___________________________
I have poor vision due to cataract, have difficulty walking due to general weakness, and have memory loss.