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Satisfaction Survey (Old)
Our community is very important to us. By completing this survey, you can help us better understand our performance. Thank you.
1.
What is your current age (in years)?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
2.
What gender do you identify as?
Cisgender Female
Cisgender Male
Nonbinary
Gender Non Conforming
Transgender (identify as male)
Transgender (identify as female)
Prefer not to say
Other (please specify)
3.
What is your sexual orientation?
Bisexual
Gay
Lesbian
Heterosexual
Questioning/Unsure
Queer
Asexual
Prefer not to say
Other (please specify)
4.
Please specify your ethnicity.
White or Caucasian
Black or African American
Latino/Latinx/Hispanic
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to say
Other (please specify)
5.
Do you identify as someone with a disability or special health care need?
Yes
No
Prefer not to say
Other (please specify)
