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* 1. Name

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* 2. Email

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* 3. Gender

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* 4. Level of education

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* 5. What is your occupation outside of politics? Have you ever worked in healthcare/ advocacy?

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* 6. Generally speaking, do you usually think of yourself as a Republican, a Democrat, an Independent, or something else?

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* 8. Is healthcare reform one of your top three platform issues?

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* 9. Why are you running for office and is healthcare (i.e. medical, mental health, environmental) apart of your message? Do you support the legalization of certain drugs? Feel free to reference goals from HealthyPeople2020.gov.

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* 10. In 2018, healthcare was the leading concern among voters. Which healthcare plan do you favor? There are many to choose from: Medicare for All, Affordible Care Act, American Health Care Act, Private Insurance, or other?

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