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1. Gender

2. Age

3. Race/Ethnicity (You may check more than one.)

4. Where do you live?

5. Which versions of the “For Me, For Us” video have you seen? (Check all that apply.)

6. How did you find out about this video?

7. Do you feel that the information in the video was useful?

8. Was the video easy to understand?

9. Was the video enjoyable to watch?

10. Did you learn any new information by watching this video?

11. Were you motivated to change any health behaviors because of watching this video?

12. Would you recommend this video to a friend or relative?

13. Overall, how do you rate the video?

14. Do you have any comments about the video?