Welcome to this survey. Press Next to begin.





Please answer the following few questions regarding your demographics.





What is your gender?





How old are you (in years)?

Input is not a number!



What is the highest level of education you have completed?





Are you currently on medication?





If you answered YES, please give a list of the medication(s) and the daily dosage for each medication you are taking




Congratulations for completing this survey! Press finish to continue.