Personal Details

THE RESULTS OF THIS SURVEY ARE CONFIDENTIAL AND WILL BE ANALYZED BY THE NORTHSIDE HEALTH & WELLNESS INITIATIVE. THE SURVEY SHOULD TAKE 10-20 MINUTES TO COMPLETE.

Question Title

* 1. Gender

Question Title

* 2. Age

Question Title

* 3. Name of intersection closest to your home (for example: Brook Rd & Sherwood Ave)

T