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First, we want to know more about you:
First Name
Last Name
What is your age?
Please choose one
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What gender do you identify with?
Please choose one
Woman
Man
Agender
Genderqueer or genderfluid
Māhū
Muxe
Non-binary
Questioning or unsure
Two-spirit
Prefer not to disclose
Additional gender category/identity not listed
Is English your first language?
Yes
No
Prefer not to disclose
What is your ethnicity? (Select all that apply)
Hispanic or Latino
White
Black or African American
Native American or American Indian
Asian
Pacific Islander
Other
Prefer not to say
What is your highest level of education completed?
Please choose one
Some High School
High School Diploma
College Certificate/Degree
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Other
What is your primary language?
Please choose one
English
Spanish
Chinese (Mandarin)
Chinese (Cantonese)
Vietnamese
Tagalog
Arabic
Korean
Russian
Haitian Creole
Portuguese
French
German
Hindi
Japanese
Other
What is your current employment background?
Please choose one
Administrative/Clerical
Agriculture/Farming
Arts/Entertainment/Media
Business/Finance (e.g., manager, accountant)
Construction
Education (e.g., teacher, professor)
Healthcare (e.g., nurse, doctor)
Legal (e.g., lawyer, paralegal)
Other (please specify)
Public service (e.g., police, firefighter)
Retail/Sales
Scientific/Research
Service industry (e.g., waiter, cleaner)
Skilled trades (e.g., electrician, carpenter)
Technology (e.g., software developer, IT specialist)
Transportation (e.g., driver, pilot)
How would you rate your ability to read?
Very Poor
Poor
OK
Good
Very Good
How confident are you with reading and understanding health information?
Not at all confident
Slightly confident
Moderately confident
Very confident
Extremely confident
How confident are you about your level of medical and health knowledge?
Not at all confident
Slightly confident
Moderately confident
Very confident
Extremely confident
11. Have you ever had any kind of radiology imaging (such as an X-ray, MRI, or CT scan) and read the report yourself, or have you ever read a radiology report on behalf of someone you were caring for?
Yes
No
Prefer not to say
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