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Surveys
2015
March
H
Health Lifestyles
Health Lifestyles
0%
Exit Survey
What is your gender?
Male
Female
What is your age?
18-24
25-44
45-64
65 +
What is your race?
Caucasian
African American
Latin American
Asian American or Pacific Islander
Native American or Alaska Native
Biracial or multiracial
What is the highest level of education you have completed?
Grammar School
High School diploma/ GED
Associate's degree
Some College/ Currently in college
Bachelor's degree
Master's degree or higher
What is your annual income?
Less than $25,000
$25,000-$50,000
$50,000- $75,000
$75,000 or more
Do you percieve yourself as healthy?
Yes
No
Do you believe in the power of prayer to a higher being?
Yes
No
How often do you visit the doctor?
Every 1-3 months
Every 4-6 months
Annually
Never
Out of the following, which type(s)of care do you receive? Please select all that apply.
Primary Care Physician
Optometry (eye/vision health)
Dentist (oral health)
Gynecologist (women's health)
Psychologist or Therapist (mental/emotional health)
None
Do you take any prescribed medication?
Yes
No
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