* 1. What is your gender?

* 2. What is your age?

* 3. Which race/ethnicity best describes you? (Please choose only one.)

* 4. Do you currently have health insurance?

* 5. Do you have access to the internet at home, place of residence, through a friend or relative, community center, public library, etc?

* 6. Have you ever heard about clinical research and clinical trials?

* 7. Would you personally participate in a clinical trial for a new drug?

* 8. If you answered yes to question 6 and/or 7, which of the following would you trust to lead the clinical trial and research? (check all that apply)

* 9. Are you interested in participating in the Hepatitis Foundation International's (HFI) Patient Registry?

* 10. Please include your contact information below:

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