Before the Bump, What have you learned? Question Title * 1. Please tell us a little about yourself. Name: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * 2. What did you learn about preconception health by viewing our Facebook page? Question Title * 3. Have you met any of our peers on campus or in the community yes no Question Title * 4. Do you know that it is very important to take a multi-vitamin containing folic acid before you become pregnant in order to receive the full benefits of preventing birth defects of the spinal column by 70%? Did you learn more about this on our Facebook page or from our peers? Yes No please comment Question Title * 5. Will you commit to making one healthy behavioral change (e.g. take vitamins with folic acid, stop smoking, obtain birth control if sexually active, get screened for STI's, make a dental appointment, commit to weight loss program if over weight), to help you to have a healthier lifestyle? If so please describe your commitment below. Question Title * 6. May we contact you in the future by email to find out how you are doing with your commitment? yes no Done