1.Demographics: What race do you identify as?

🞎 American Indian or Alaska Native

🞎 Asian or Pacific Islander

🞎 Black

🞎 White

🞎 Hispanic

2.What gender do you identify with?

🞎 Male

🞎 Female

🞎 Nonbinary/two spirit

🞎 Prefer not to say

3.What is your age range?

🞎 19-24

🞎 25-34

🞎 35-44

🞎 45-54

🞎 55-64

🞎 65 and above

4.Do you live in the Pawnee Nation service jurisdiction (Pawnee, Payne, or Kay County)?

🞎 Yes

No (If not, where do you live)?

5.Do you work in the Pawnee Nation service jurisdiction (Pawnee, Payne, or Kay County)?

🞎 Yes

🞎 No

6.In the last year, was there a time when you needed healthcare including medical care or dental care, but were not able to receive it?

🞎 Yes

🞎 No