Pre-Survey for Patients Question Title * 1. Gender Male Female Other (please specify) Question Title * 2. Age Under 12 12-17 18-24 25-34 35-44 45-53 53 or older Question Title * 3. What is your ethnicity? (Check all that apply) White Hispanic African American Asian/ Pacific American Other (please specify) Question Title * 4. What county do you live in? Adams Clay Nuckolls Webster Question Title * 5. On average, how many hours do you spend in the sun a day? 1-2 2-4 4-5 More than 5 hours Question Title * 6. Do you wear sunscreen when you're outside? Always Most of the time Sometimes Never Question Title * 7. Do you wear protective clothing? (Long sleeves, hats, sunglasses, etc.) Always Most of the time Sometimes Never Question Title * 8. How often do you tan (indoor and/or outdoor)? 1-2 hours per week 2-3 hours per week 3-5 hours per week 5 or more hours per week Question Title * 9. How aware are you of skin cancer in the United States? Mostly Aware Relatively aware I've heard of it Not at all Done