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How It Works
We need some basic information about you so we can ask the right questions:
What is Your Name?
*
Are you male or female?
*
Male
Female
When were you born?
*
Month
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
Day
Year
What race do you mostly identify with?
*
Aleutian, Alaska native, Eskimo, or American Indian
Asian
Black
White
Pacific Islander
Other
I Don't Know
Are you of Hispanic Origin?
*
Yes
No
What city and state do you live in?
Where do you go for primary care?
Atrium
Novant
Wake Forest
Integrity Health
Tryon Medical Partners
Other
What type of insurance coverage do you have?
No Coverage - Uninsured
Medicaid Only
Medicare Only
Veteran Health Coverage
Employer Sponsored
Private Health Coverage
Healthshare
Other
What type of occupation do you have?
Administrative
Management
Healthcare Worker
Law Enforcement
Technology
Electrical Trade
Plumbing Trade
HVAC Trade
Other
What is your annual income range?
less than 50k
50k-100k
100k-150k
150k-200k
more than 200k
Do you want to
Create An Account
? You can save your results, track your progress over time, and get more customized results. Don't worry, we'll save your progress.
Let's Start!