Background Information

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* 1. Which of the following best describes you?

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* 2. If you provide care for other people who are living with sickle cell, list how many people you provide care for in each of the following age ranges. Enter a zero for each age category that does not apply to you.

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* 3. What is your gender?

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

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* 5. Do you live in the United States?

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* 6. If you live in the United States, what is your five-digit zip code? If you do not live in the United States, please indicate the country in which you live.

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* 7. As of today, what is your age?

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* 8. Do you have challenges or difficulties with any of the following? Select all that apply.

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* 9. Is English the primary language spoken in your home?

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