Black Women's Health Survey Black Women's Health Focus Group Survey Please fill out this survey and someone will reach out to you to shortly to discuss your participation in a black women's health focus group. OK Question Title * 1. What is your first name? OK Question Title * 2. What is your last name? OK Question Title * 3. What is your email address? OK Question Title * 4. What is your home phone number? OK Question Title * 5. What is your cell phone number? OK Question Title * 6. What dates and times are you available? (Please check all that apply) Tuesday, October 16, 2018 5:30 - 7:30 PM Wednesday, October 17, 2018 1:00 - 3:00 PM Wednesday, October 17, 2018 5:30 - 7:30 PM Thursday, October 18,2018 5:30 - 7:30 PM Tuesday, October 23, 2018 1:00 - 3:00 PM Tuesday, October 23, 2018 5:30 - 7:30 PM Wednesday, October 24, 2018 5:30 - 7:30 PM Thursday, October 25, 2018 5:30 - 7:30 PM OK DONE