Date of Birth:(Required) MM slash DD slash YYYY Zip Code:(Required) Gender Identity:(Required)FemaleMaleNonbinaryTransgenderOtherPrefer not to sayHas the consumer received a COVID-19 Vaccine?(Required)YesNoHow many doses did you receive?(Required)1st Dose1st & 2nd Dose1st & 2nd Dose with BoosterPrefer not to sayI have a primary care physician:(Required)YesNoNot SureThe last time I was seen by a Primary Care Physican was:(Required)Within 3-6 months agoWithin 6-12 monthsWhen something hurtI'm not sure the last time I was seenI'm someone who has been directly impacted by cancer:(Required)YesNoI know someone who has been directly impacted by cancer:(Required)YesNoThe last time I participated in blood work and screening for physical health concerns was:(Required)Within the last 3-6 monthsWithin the last 6-12 monthsI'm not sure the last time I was seenWhen I have go to the see my doctor, I feel comfortable telling them my health concerns:(Required)Not at allSometimesMost of the timeMajority of the timeAll the time