1. What is your gender?

2. What is your age?

3. Which race/ethnicity best describes you? (Please choose only one.)

4. Do you currently have health insurance?

5. Do you have access to the internet at home, place of residence, through a friend or relative, community center, public library, etc?

6. Have you ever heard about clinical research and clinical trials?

7. Would you personally participate in a clinical trial for a new drug?

8. If you answered yes to question 6 and/or 7, which of the following would you trust to lead the clinical trial and research? (check all that apply)

9. Are you interested in participating in the Hepatitis Foundation International's (HFI) Patient Registry?

10. Please include your contact information below: