Mercy Wellness Survey NATIONAL

Please tell us a little about you.

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* 1. In which zip code is your home located? (enter 5-digit zip code; for example 95404).

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* 2. What is your gender?

Male

Female

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* 3. Which category below includes your age?

18-29

30-39

40-49

50-59

60-69

70 or older

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* 4. Which of the following describes your employment status?

Employed full time

Employed part time

Unemployed but looking for work

Retired

Unable to work due to disability