MMHC: C Health (DEC21)

Study Screener

Question Title

* 1. What is your contact information?

Name

Email Address

Phone Number

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* 2. What is your age?

Question Title

* 3. What is your preferred gender designation?

Male

Female

Transgender Male (FTM)

Transgender Female (MTF)

Gender Variant/Non-Conforming

Prefer Not to Answer

Not Listed

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* 4. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Other (please specify)

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* 5. In which region do you currently reside?

California- Northern

California- Southern

Colorado- Denver/Boulder/Northern/Mountain areas

Colorado- Southern

Hawaii

Georgia

Maryland

Oregon

Virginia

Washington – South West (e.g. Vancouver, Longview)

Washington – Central/Northern (e.g. Seattle, Spokane, Tacoma)

Washington D.C.

Other (please specify)

Question Title

* 6. Which of the following categories best describes your employment status?

Employed and working 40 or more hours per week

Employed and working 1-39 hours per week

Not employed and looking for work

Not employed and NOT looking for work

Retired

Disabled or not able to work

Other (please specify)

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* 7. What is your current occupation or profession? If you are Retired, Unemployed, Student, or a Stay-at-Home spouse, please indicate which AND specify your previous occupation/profession or study if any.

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* 8. Do you or your spouse, currently or in the past, work for any of the following industries?

Market or user research

Marketing, advertising, or public relations

Graphic, product, UX, or web design

Information technology or software development

Health care (patient care or insurance)

Other (please specify)

None of the above

11% of survey complete.