Health care study Question Title * 1. What is your first name? Question Title * 2. What is your last name? Question Title * 3. Phone number to reach you Question Title * 4. E-Mail Address Question Title * 5. Your age Question Title * 6. What is your gender? Female Male Other Question Title * 7. What is your street address? Question Title * 8. In what city do you live? Question Title * 9. What state do you reside in? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Question Title * 10. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305) Next