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* 1. Which of the following best describes you?

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* 2. Please enter your birthdate.

Date

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* 3. What is your zip code?

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* 4. What is your marital status?

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* 5. How many children (18 years of age or under) are living in your household?

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* 6. What is the highest level of school you have completed, or the highest degree you have earned?

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* 7. What is your current employment status?

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* 8. What is your approximate annual household income?

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* 9. In a typical week, how many days do you exercise or participate in sports?

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* 10. On average, how often do you travel for pleasure?

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* 11. In the past 12 months, which of the following hobbies have you participated in? (please select all that apply)

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* 12. Which social media networks do you regularly use? (please select all that apply)

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* 13. What type of radio broadcasting do you listen to? (please select all that apply)

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* 14. What type of music/programming do you listen to? (please select all that apply)

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* 15. How do you watch television programming? (please select all that apply)

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* 16. In the past year, which of the following sporting events have you watched in-person or on television? (please select all that apply)

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* 17. In the next 12 months, how are you most likely to spend your disposable income? (please select all that apply)

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* 18. Have you had any of the following?

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* 19. Have you ever had any cosmetic or elective procedures?

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* 20. Do you regularly wear glasses or contacts?

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* 21. Do you have an astigmatism?

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* 22. There are many myths about Lasik ... which ones have you heard? (please select all that apply)

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* 23. Have you ever had or ever considered having Lasik?

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