LGBT Health Care Experiences

 
We appreciate your willingness to complete this short survey to help us better understand and improve the healthcare experiences and cancer awareness of the LGBTQI population in California. To be eligible to take the survey, you need to be 18 years of age or older, self-identified as LGBTQI and living in California. The survey should take about 5-10 minutes to complete. Please answer every question. You may opt out of the survey at any time. We greatly appreciate your participation.
1. Which category below includes your age?
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2. What is your self-asserted gender expression?
3. What is your biological gender?
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4. With what ethnicity/race do you identify?
5. What was the highest grade or year of school you completed?
6. Would you prefer that your sexual orientation and gender expression be included in your medical record?
7. What is your approximate average household income?
8. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)
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