Access to Healthcare - Champaign County

Question Title

* 1. Are you male or female?

Male

Female

Question Title

* 2. What is your age?

18-24

25-30

31-35

36-40

41-45

46-50

51-55

55-60

61-65

66 or older

Question Title

* 3. Do you receive routine physical examinations or health check-ups?

Yes

No