SurveyMonkey Powered Online Survey

Thank You Participating in this Survey

Answers to the following questions will be completely anonymous. Thank you for sharing your thoughts about ObamaCare, also known as the Affordable Care Act.

ALL OF YOUR ANSWERS TO THIS SURVEY WILL BE KEPT COMPLETELY CONFIDENTIAL.

Question Title

* 1. Please tell us about you and where you're from below. (We will not share your information. The information you provide below is completely confidential).

City/Town:

State:

ZIP:

Email Address:

Question Title

* 2. When is your birthday?

Input values (ex. 05/15/1975)

Date

Question Title

* 3. What best describes you below?

I am the parent of a child diagnosed with autism.

I am the parent of an adult child diagnosed with autism

I care for someone diagnosed with autism

Other (please specify what best describes you)