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Please type in your age, gender, and occupation.
   
 
 
 
What is your marital status?
 
Single
 
Married
 
Divorced
 
Widowed
 
 
 
What is your combined income?
   
 
 
 
Is alternative medicine (massage, acupuncture, chiropractic, herbalism, therapy, etc.) part of your self-care routine?
 
Yes
 
No
 
Likely in the next 3 months
 
Likely in the next 6 months
 
Likely in the next 12 months
 
 
 
Do you have a spiritual or religious affiliation?
 
Yes
 
No
 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Discover
 
Diners Club