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Native American Health Coalition Urban Indian Health Needs Assessment

 

1. What is your zip code?

What is your zip code?

2. Is your spouse/partner also completing a survey?

Is your spouse/partner also completing a survey?   Yes No I don't know

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3. What is your gender?

What is your gender?   Male Female

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4. What is your age?

What is your age?

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5. What is your tribal affiliation?

What is your tribal affiliation?

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6. Are you registered/enrolled with your tribe?

Are you registered/enrolled with your tribe?   Yes No