Skip to content
LGBT Health and Preventative Care
3.
PART ONE: Participant Demographic & Predisposing and Enabling Factors
*
1.
What is your age?
(Required.)
18-21
22-30
31-40
41-50
51-60
61+
2.
Which of the following best describes how you identify your gender?
Cisgender female
Cisgender male
Transgender (FTM)
Transgender (MTF)
Other (please specify)
3.
Which of the following best describes your sexual orientation?
Lesbian
Gay
Bisexual
Asexual
Heterosexual
Other (please specify)
4.
Which of the following best describes your current relationship status?
Married
Widowed
Divorced
Separated
In domestic partnership or civil union
Single, but cohabitating with a significant other
Single, never married
Other (please specify)
5.
Which of the following categories best describes your employment status?
Employed, working full-time
Employed, working part-time
Not employed, looking for work
Not employed, not looking for work
Retired
Disabled, not able to work
Other (please specify)
Current Progress,
0 of 16 answered