Please provide your contact information

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* 1. Please provide your contact information

What is your gender?

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* 2. What is your gender?

What is your marital status?

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* 3. What is your marital status?

What is your date of birth? (MM/DD/YYYY)

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* 4. What is your date of birth? (MM/DD/YYYY)

What was your household income during the past year?

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* 5. What was your household income during the past year?

What is your highest level of completed education?

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* 6. What is your highest level of completed education?

Which of the following best describes your ethnicity?

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* 7. Which of the following best describes your ethnicity?

How many people in the following age groups live in your household?

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* 8. How many people in the following age groups live in your household?

Do you own any of the following types of pets? (Select all that apply)

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* 9. Do you own any of the following types of pets? (Select all that apply)

Have you or anyone in your household been diagnosed with any of the following? (Please select all that apply)

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* 10. Have you or anyone in your household been diagnosed with any of the following? (Please select all that apply)

Do you have any dietary restrictions?

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* 11. Do you have any dietary restrictions?

Are you a medical professional?

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* 12. Are you a medical professional?

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