Thank you for taking the time to take this survey. We ask that each person in your household take this survey, so we can get a better understanding of the health symptoms you are experiencing.
Please answer the following general questions:

Question Title

Name (Required.)

Question Title

Date of Birth (Required.)

Date

Question Title

Address (Required.)

Question Title

How Long Have You Lived at your Current Address? (Required.)

Question Title

How many miles (Approximately) are you from the Landfill? (Required.)

Question Title

What is the main address where you were exposed to landfill gases? (Required.)

Question Title

Is that address your home, work, or other? (Required.)

Question Title

How many people live in your household (including you)?

T