* 1. What is your age?

* 2. What is your nationality? (Ex: 50% Irish, 50% Italian)

* 3. What is your current religion, if any?

* 4. What most influenced your choice of religion? Please explain.

* 5. In what country do you currently live?

* 6. Have you ever experienced the loss of a loved one?

* 7. What influences your traditions surrounding death?

* 8. What is your level of knowledge of hospice care?

* 9. Do you have an idea of how you expect to be taken care of when you pass?

* 10. What is your level of comfort talking about death?

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