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TAKE SURVEY AND ENTER FOR YOUR CHANCE TO WIN A $100 AMEX GIFT CARD

1. How do you describe your gender identity?
(SELECT ONE)

2. What best describes your sexual identity?
(SELECT ONE)

3. What is your HIV status

4. What is your age?

5. Select the race/ethnic group(s) that best describe(s) you?

6. Is your Doctor/Health Provider located in the City of West Hollywood?

7. Do you live, work, own property, spend a significant amount of time, or are homeless in West Hollywood?

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