* 1. Please provide your contact information

* 2. What is your gender?

* 3. What is your marital status?

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

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

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

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

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

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

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

* 11. Do you have any dietary restrictions?

* 12. Are you a medical professional?

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