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Mercy Wellness Survey NATIONAL
Please tell us a little about you.
*
1.
In which zip code is your home located? (enter 5-digit zip code; for example 95404).
(Required.)
2.
What is your gender?
Male
Female
*
3.
Which category below includes your age?
(Required.)
18-29
30-39
40-49
50-59
60-69
70 or older
4.
Which of the following describes your employment status?
Employed full time
Employed part time
Unemployed but looking for work
Retired
Unable to work due to disability
Current Progress,
0 of 13 answered
