Lyme Awareness Survey - Starting November 2013 About You Question Title * 1. Gender Male Female Question Title * 2. Age <18 18-35 36-64 65+ Question Title * 3. Race White African-American (Black) Asian Other (please specify) Question Title * 4. Ethnicity Hispanic Non-Hispanic Unknown Question Title * 5. Educational attainment High school or less Some college Bachelor’s degree Graduate’s degree Question Title * 6. Home zip code Question Title * 7. Length of time in Loudoun Less than 1 year 1-5 years 6-10 years More than 10 years Question Title * 8. Do you believe that you have or have had Lyme disease? Yes No Next