Healthcare Study - November 2016 6% of survey complete. Question Title * 1. What is your first name? Question Title * 2. What is your last name? Question Title * 3. If someone referred you for this study, please type that person's full name Question Title * 4. What is your age? (optional) Question Title * 5. What is/are your personal email address/es? Email address 1 Email address 2 Question Title * 6. What phone number/s can we reach you at? Phone # 1 Phone # 2 Question Title * 7. In what city and state do you live? City: State: Question Title * 8. Would you like to subscribe to our participant pool (database)?- If you subscribe, you will receive notifications about paid research study opportunities in your area. Yes No Question Title * 9. What is the highest level of education that you have completed? No formal education Some high school High school degree or equivalent (eg. GED) Trade/technical/vocational school College (Bachelor’s Degree) University or above (Master’s or Doctoral Degree) Question Title * 10. What is your current employment status? Full time Part time Student Retired Unemployed- in process of looking for a job Unemployed- NOT in the process of looking for a job Next