1.Email Address

2.Which social media platforms do you use?

Instagram

Facebook

LinkedIn

X (Formerly known as Twitter)

Threads

TikTok

Snap Chat

Pinterest

Other (please specify)

None of the above

3.Which social media platforms do you follow us on?

Instagram

Facebook

LinkedIn

X (Formerly known as Twitter)

None of the above

4.What type of social media content would you like to see more of?

5.Would you be interested in receiving text messages in addition to emails from us?

Yes

No

6.If you answered "Yes" to the previous question, please provide us a cell phone number.

7.What ways do you prefer to give?

Cash

Check

Debit/Credit through a website

Venmo

Other (please specify)

None of the above

8.How did you first hear about Alliance Medical Ministry?

Social Media

Our Website

Through an Organization such as a Church, School, Job, etc.

Word of Mouth

Health Fair

A Patient

Other (please specify)

9.When is your Birthday? MM/DD