Foot Care SE-2704 Question Title * 1. Please fill out the information below. Name: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * 2. What is your current age? Question Title * 3. What is your gender? Question Title * 4. What is your household annual income? Question Title * 5. What is your current employment status? Question Title * 6. What is your highest level of education? Question Title * 7. What is your ethnicity? Question Title * 8. When it comes to decisions about your household's pharmaceutical and health care purchases, what role do you play? I am primary decision maker I share I have some imput I am not involved Question Title * 9. Please indicate which specific brand(s) of footcare products you have used in the last 12 month? If none, then just select none. Aetrex Airplus Compound W Dr Scholl's Foot Petals Gold Blond Odor Eaters Pro Foot Spenco Store Brands None of the above Question Title * 10. Please answer yes or no to the following questions. Yes No Keeping your balance when you walk Keeping your balance when you walk Yes Keeping your balance when you walk No Do you use a cane Do you use a cane Yes Do you use a cane No Have you fallen due to balance issues Have you fallen due to balance issues Yes Have you fallen due to balance issues No Do you tend to lean on things to maintain your balance Do you tend to lean on things to maintain your balance Yes Do you tend to lean on things to maintain your balance No Question Title * 11. Have you ever had any of the following procedures? Appendectomy Knee replacement Hip replacement Hernia repair None of the above Done