Marital Status: Married Single
Employment Status: Employed Unemployed
Age:
Education:
Elementary School
Middle School
High School
College
Have you ever attended any Health Presentation? Yes No
Please Indicate your computer skill level:
Windows:
Beginner Intermediate Advanced
MS Word:
Beginner Intermediate Advanced
MS Excel:
Beginner Intermediate Advanced
MS Access :
Beginner Intermediate Advanced
Internet:
Beginner Intermediate Advanced
Sign:
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