* 1. Please fill in the information below.

* 2. What is your gender?

* 3. What is your current age?

* 4. What is your marital status?

We are conducting a study to evaluate the usability and safety of a new device for injection a medication. I have a few questions I need answered to make sure you qualify.

* 5. What is the highest grade level you achieved in an english-language school?

* 6. Do you have at least one child between the ages of 2 and 17 living with you?

* 7. How old is your child?

* 8. Does your child receive daily injections of a growth hormone?

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