Please fill this demographics form out to the best of your ability. Use the same E-mail you used to sign the  consent form.

Name *
Age *
Gender *
Sexual Orientation *
Ethnicity *
Race *
Choose all that you identify with.
Religion *
Education *
Annual Household Income *
Please estimate if you are unsure.
Marital Status *
Employment Status *
Medical History
This section is completely optional and it is up to you to decide how much information you would like to share with us. Your information will be stored and shared as indicated on the consent form you have already agreed to and signed.