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* 1. What county do you live in?

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* 2. what is your zip code?

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* 3. Age:

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* 4. Race(s) (check all that apply)

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* 5. Ethnicity:

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

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* 7. Household Yearly Income:

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* 8. Have you ever heard of the words pre-conception or inter-conception health?

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* 9. Where do you seek healthcare information or advice?

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* 10. What challenges do you face when accessing healthcare services?

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* 11. What challenges do you face when accessing social services to help with housing, food, employment, and everyday basic needs

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* 12. Do you have health insurance coverage

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* 13. Do you have insurance coverage for dental or vision health?

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* 14. What does it mean to be "healthy" before you get pregnant?

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* 15. Are you currently receiving treatment for any chronic health conditions?

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* 16. How many minutes of exercise do you get each week?

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* 17. During the past 30 days, on how many days did you smoke or use tobacco products?

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* 18. How many servings of fruits and vegetables do you eat each day?

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* 19. Have you seen a doctor or other healthcare provider in the past 12 months for a women wellness exam? (Not including a visit to the emergency department or urgent care).

A womens wellness visit is a yearly exam that includes having a physical or reproductive exam where a doctor or other healthcare professional offers insight on how to maintain a healthy lifestyle and conducts screenings for health issues.

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* 20. Have you seen a dentist in the past 12 months?

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* 21. Have you seen an eye doctor in the past 12 months?

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* 22. Have you seen a mental health care provider in the 3 months?

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* 23. Are you pregnant or have you been pregnant in the past 12 months?

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* 24. What type of birth control method have you used after giving birth or are you currently using?

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* 25. In the past 6 months, have you done any of the following because you were unable to afford to do so?

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* 26. In the past six months, have you struggled to pay your rent or mortgage?

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* 27. Do you, or someone in your household, work more than one job to pay your bills?

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* 28. Do you have access to affordable childcare?

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* 29. Have you, or anyone in your household been diagnosis with Covid-19 over the past year?

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* 30. Has your household been financially impacted by Covid-19?

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* 31. How did you hear about our survey?

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