Screener

Survey Goals

You are invited to participate in a community needs assessment of the LGBT community in your state. The goal of this survey is to gather information to better understand the health status and health care experience of you and your community. With your input, we will identify gaps in community services so that we can create a plan to address them.

Privacy

Your responses to this survey are anonymous. We will not ask you for your name, address, or phone number. All responses will be kept confidentially. We do not record participants' computer user IDs, IP addresses, and other tracking information. You will not be identified in any way. Saved data will be stored in a secure place. Confidentiality will be maintained to the extent possible by law. Only group data will be collected and analyzed for determining programs that are relevant to the needs of today’s LGBT community. Your personally identifiable information will not be revealed to any third parties.

Time

The survey will take approximately 15  minutes to complete, depending on how much you would like to share. You may stop the survey or refuse to answer any question at any time. Please complete the entire survey in one session, as all your opinions and ideas are important to us. Your assistance is truly valued, and we thank you in advance for your participation.

* 1. Across your lifetime, do you consider yourself to be Lesbian, Gay, Bisexual or Transgender?

* 2. What is your age?

* 3. What is your ZIP code?

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