Healthcare Questionnaire Demographic Background Question Title * 1. What is your gender? Male Female Other (please specify) Question Title * 2. What is your race or ethnicity? White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race (please self-identify below) Question Title * 3. What is your age? 18-24 25-34 35-44 45-54 55-64 65+ Next
