Canadian Social Survey - Quality of Life, Health and Impacts of Rising Prices

Location of residence (DEM) - Question identifier:DEM_Q15

To determine which geographic region you live in, provide your postal code.

Postal code

Long Answer Length = 7

Sex and gender (GDR) - Question identifier:GDR_R05

The following questions are about sex at birth, gender and age.

Sex and gender (GDR) - Question identifier:GDR_Q05

What was your sex at birth?

• 1: Male
• 2: Female

Sex and gender (GDR) - Question identifier:GDR_Q10

What is your gender?

• 1: Male
• 2: Female
• 3: Or please specify

Sex and gender (GDR) - Question identifier:GDR_R15

Please verify that all of the information is correct.

If all the information is correct, press the Next button.

To make changes, press the Previous button.

Your information

Sex assigned at birth: [Male/Female/Information not provided]

Gender: [Male/Female/Specify your gender/Information not provided]

Age (AGE) - Question identifier:AGE_Q01A

What is your date of birth?

Year

Min = 0000; Max = 9999

Age (AGE) - Question identifier:AGE_Q01B

What is your date of birth?

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

Age (AGE) - Question identifier:AGE_Q01C

What is your date of birth?

Day

• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10
• 11: 11
• 12: 12
• 13: 13
• 14: 14
• 15: 15
• 16: 16
• 17: 17
• 18: 18
• 19: 19
• 20: 20
• 21: 21
• 22: 22
• 23: 23
• 24: 24
• 25: 25
• 26: 26
• 27: 27
• 28: 28
• 29: 29
• 30: 30
• 31: 31

Age (AGE) - Question identifier:AGE_Q02

What is your age?

Age in years

Min = 0; Max = 999

Occupancy (DWL) - Question identifier:DWL_Q01A

Is this dwelling owned by a member of this household?

• 1: Yes, owned, even if it is still being paid for
• 2: No, rented, even if no cash rent is paid

Life satisfaction (LSM) - Question identifier:LSM_Q01

Using a scale of 0 to 10, where 0 means "Very dissatisfied" and 10 means "Very satisfied", how do you feel about your life as a whole right now?

• 00: 0 — Very dissatisfied
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Very satisfied

Sense of meaning and purpose (MP) - Question identifier:MP_Q01

Using a scale of 0 to 10, where 0 means "Not at all" and 10 means "Completely", to what extent do you feel the things you do in your life are worthwhile?

• 00: 0 — Not at all
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely

General health (GEN) - Question identifier:GEN_R01

The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

General health (GEN) - Question identifier:GEN_Q01

In general, how is your health?

• 1: Excellent
• 2: Very good
• 3: Good
• 4: Fair
• 5: Poor

General health (GEN) - Question identifier:GEN_Q02

In general, how is your mental health?

• 1: Excellent
• 2: Very good
• 3: Good
• 4: Fair
• 5: Poor

Future outlook (FO) - Question identifier:FO_Q01

Thinking about your life in general, how often would you say you have a hopeful view of the future?

• 1: Always
• 2: Often
• 3: Sometimes
• 4: Rarely
• 5: Never

Loneliness (LON) - Question identifier:LON_Q01

How often do you feel lonely?

• 1: Always
• 2: Often
• 3: Sometimes
• 4: Rarely
• 5: Never

Sense of belonging to local community (SBL) - Question identifier:SBL_Q100

How would you describe your sense of belonging to your local community?

• 1: Very strong
• 2: Somewhat strong
• 3: Somewhat weak
• 4: Very weak
• 5: No opinion

Someone to count on (RES) - Question identifier:RES_Q06

How often would you say you have people you can depend on to help you when you really need it?

• 1: Always
• 2: Often
• 3: Sometimes
• 4: Rarely
• 5: Never

Main activity (MAC) - Question identifier:MAC_Q05

Last week, was your main activity working at a paid job or business, looking for paid work, going to school, caring for children, household work, retired or something else?

• 01: Working at a paid job or business
• 02: Vacation from paid work
• 03: Looking for paid work
• 04: Going to school, including vacation from school
• 05: Caring for children
• 06: Household work
• 07: Retired
• 08: Maternity, paternity or parental leave
• 09: Long term illness
• 10: Volunteering
• 11: Care-giving other than for children
• 12: Other

Satisfaction (DOS) - Question identifier:DOS_Q08

On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with the amount of time you have to do the things that you like doing?

• 00: 0 — Not at all satisfied
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely satisfied

Satisfaction (DOS) - Question identifier:DOS_Q09

On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with the quality of your local environment such as access to green space, and air or water quality?

• 00: 0 — Not at all satisfied
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely satisfied

Trust in the media (TM) - Question identifier:TM_R05

The following questions are about trust in media. The media are communication outlets that deliver news and information through the Internet, social media, television, radio and in print.

Trust in the media (TM) - Question identifier:TM_Q05

On a scale of 0 to 10, where 0 means "Not at all" and 10 means "Completely", to what extent do you generally trust the news or information you receive from the media?

• 00: 0 — Not at all
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely

Trust in the media (TM) - Question identifier:TM_Q10

From which source do you get most of your news or information?

• 1: Internet, other than social media (Include: web pages, podcasts, blogs)
• 2: Social media (Include websites, forums and applications where users create and share content or participate in social networking.
  e.g., Facebook, Instagram, Twitter, LinkedIn, TikTok)
• 3: Television
• 4: Radio
• 5: Print media (Include: newspapers, magazines)
• 6: Other

Trust in the media (TM) - Question identifier:TM_R15

Please rate your level of trust in these sources, whether you use them or not.

Trust in the media (TM) - Question identifier:TM_Q15

On a scale of 0 to 10, where 0 means "Not at all" and 10 means "Completely", to what extent do you generally trust the news or information you receive from the Internet, other than social media?

• 00: 0 — Not at all
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely

Trust in the media (TM) - Question identifier:TM_Q20

On a scale of 0 to 10, where 0 means "Not at all" and 10 means "Completely", to what extent do you generally trust the news or information you receive from social media?

• 00: 0 — Not at all
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely

Trust in the media (TM) - Question identifier:TM_Q25

On a scale of 0 to 10, where 0 means "Not at all" and 10 means "Completely", to what extent do you generally trust the news or information you receive from television?

• 00: 0 — Not at all
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely

Trust in the media (TM) - Question identifier:TM_Q30

On a scale of 0 to 10, where 0 means "Not at all" and 10 means "Completely", to what extent do you generally trust the news or information you receive from radio?

• 00: 0 — Not at all
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely

Trust in the media (TM) - Question identifier:TM_Q35

On a scale of 0 to 10, where 0 means "Not at all" and 10 means "Completely", to what extent do you generally trust the news or information you receive from print media?

• 00: 0 — Not at all
• 01: 1
• 02: 2
• 03: 3
• 04: 4
• 05: 5
• 06: 6
• 07: 7
• 08: 8
• 09: 9
• 10: 10 — Completely

Discrimination or unfair treatment in Canada (DIS) - Question identifier:DIS_R05

The next questions are about your possible experiences with discrimination or unfair treatment in Canada.

Discrimination or unfair treatment in Canada (DIS) - Question identifier:DIS_Q05

In the past 5 years, have you experienced discrimination or been treated unfairly by others in Canada because of any of the following?

• 01: Your Indigenous identity
• 02: Your ethnicity or culture
• 03: Your race or skin colour
• 04: Your religion
• 05: Your language
• 06: Your accent
• 07: Your physical appearance (Include discrimination on the basis of weight, height, hair style or colour, clothing, jewelry, tattoos and other physical characteristics. Exclude discrimination on the basis of skin colour.)
• 08: Your sex (Sex refers to sex assigned at birth.)
• 09: Your sexual orientation (e.g., heterosexual, lesbian, gay, bisexual)
• 10: Your gender identity or expression (Include gender diverse identities such as two-spirit or nonbinary.)
• 11: Your age
• 12: A physical or mental disability
• 13: Some other reason
• 14: Did not experience discrimination

Discrimination or unfair treatment in Canada (DIS) - Question identifier:DIS_Q10

In what types of situations have you experienced discrimination in Canada in the past 5 years?

• 01: In a store, bank or restaurant
• 02: When attending school or classes
• 03: On the Internet, including social media platforms
• 04: At work or when applying for a job or promotion
• 05: When seeking or applying for housing (e.g., buying or renting)
• 06: When interacting with the police
• 07: When interacting with the courts
• 08: When crossing the border into Canada (Exclude incidences of discrimination upon leaving Canada.)
• 09: While attending social gatherings or by or among friends or family
• 10: While using public areas, such as parks and sidewalks
• 11: While using public transit, such as buses, trains or taxis
• 12: When seeing a medical health professional or in other health care settings (Medical health professionals may include doctors, nurses, physiotherapists, etc.
  In health care settings may include at hospitals, clinics, dental offices, etc.)
• 13: Any other situation

Financial well-being (EHA) - Question identifier:EHA_Q10

In the past 12 months, how difficult or easy was it for your household to meet its financial needs in terms of transportation, housing, food, clothing and other necessary expenses?

• 1: Very difficult
• 2: Difficult
• 3: Neither difficult nor easy
• 4: Easy
• 5: Very easy

Impacts of rising prices (IRP) - Question identifier:IRP_R05

When answering the following questions, please think of recent rising prices. There may be various factors influencing your concerns or decisions, but your responses should focus on recent price increases.

Impacts of rising prices (IRP) - Question identifier:IRP_Q05

Are rising prices affecting your ability to meet day-to-day expenses

• 1: Yes, a lot
• 2: Yes, somewhat
• 3: No

Impacts of rising prices (IRP) - Question identifier:IRP_Q10

Are you concerned with the impact that rising prices may have on your ability to meet day-to-day expenses over the next 6 months?

• 1: Yes, very concerned
• 2: Yes, somewhat concerned
• 3: No, not concerned

Impacts of rising prices (IRP) - Question identifier:IRP_Q15

Thinking about yourself, family, friends, and people in your community, are you concerned about rising food prices?

• 1: Yes, very concerned
• 2: Yes, somewhat concerned
• 3: No, not concerned

Impacts of rising prices (IRP) - Question identifier:IRP_Q20

Due to rising food prices, do you think you or other household members will have to obtain food or meals, at no cost to you, from a community organization over the next 6 months?

• 1: Yes, very likely
• 2: Yes, somewhat likely
• 3: No, not likely

Impacts of rising prices (IRP) - Question identifier:IRP_Q25

Are you concerned with your ability to afford housing or rent because of rising housing prices?

• 1: Yes, very concerned
• 2: Yes, somewhat concerned
• 3: No, not concerned

Impacts of rising prices (IRP) - Question identifier:IRP_Q27

Are you concerned with other people's ability to afford housing or rent because of rising housing costs?

• 1: Yes, very concerned
• 2: Yes, somewhat concerned
• 3: No, not concerned

Impacts of rising prices (IRP) - Question identifier:IRP_Q30

Have rising housing prices or rents influenced decisions about whether to move from your current residence within the last 6 months?

• 1: I wanted to buy a home or move to a new rental, but did not because of rising prices
• 2: I purchased a home or moved to a new rental sooner than planned, or chose a more affordable option, because of rising prices (e.g., purchasing a house or moving to a new rental before prices potentially rise more, downsizing to a more affordable house or rental)
• 3: I moved within the last 6 months and would have done so regardless of rising prices
• 4: I did not consider moving within the last 6 months

Impacts of rising prices (IRP) - Question identifier:IRP_Q35

Are you concerned with rising gasoline prices?

• 1: Yes, very concerned
• 2: Yes, somewhat concerned
• 3: No, not concerned
• 4: Not applicable — I do not purchase gasoline, and do not plan to do so in the next 6 months

Impacts of rising prices (IRP) - Question identifier:IRP_Q40

In the past 6 months, in which area have you been most affected by rising prices?

• 1: Transportation (e.g., gasoline, vehicles, public transportation, ride sharing, taxis, flights)
• 2: Shelter (Include housing costs such as rent, utilities, repairs and renovations.)
• 3: Food (e.g., groceries, dining out, food delivery, take-out)
• 4: Recreation (e.g., travelling, sports equipment, movies, music, electronics, social activities)
• 5: Household operations (e.g., furniture, appliances, internet, phone, child care, financial services, pet care, clothing)
• 6: Education (Include tuition and school supplies.)

Impacts of rising prices (IRP) - Question identifier:IRP_Q45

In the past 6 months, what have you started doing, or done more than before, to deal with rising prices?

• 1: Sought out sales and promotions (Include the use of price comparison applications or services.)
• 2: Purchased cheaper alternatives, brands or items
• 3: Delayed a purchase
• 4: Other changes in purchasing habits (e.g., purchasing meat less often, getting take-out food or delivery less often, spending less on recreation and leisure, repairing items instead of replacing them, buying used goods online, reducing overconsumption)
• 5: Used community services (e.g., food banks, thrift stores, community centres, school programs, faith-based organizations, community gardens)
• 6: None of the above

Impacts of rising prices (IRP) - Question identifier:IRP_Q50

In the past 6 months, due to rising prices, did you have to borrow money to meet day-to-day expenses?

• 1: Yes, often
• 2: Yes, sometimes
• 3: No

Impacts of rising prices (IRP) - Question identifier:IRP_Q55

In the past 6 months, how have rising prices of day-to-day expenses affected your ability to save money?

• 1: I have had to draw on my savings to pay my expenses
• 2: I have not had to draw on my savings, but I am saving less each month
• 3: I am no longer able to save money each month
• 4: My savings have not been affected
• 5: My savings have increased
• 6: I do not usually save money

Impacts of rising prices (IRP) - Question identifier:IRP_Q60

In the past 6 months, have you made any major non-essential purchases sooner than planned, because of expected shortages in supply or rising prices?

• 1: Yes
• 2: No, supply shortages or rising prices did not impact my decision making
• 3: No, I had not planned any major non-essential purchases

Impacts of rising prices (IRP) - Question identifier:IRP_Q65

In the past 6 months, have you postponed any major non-essential purchases because of expected shortages in supply or rising prices?

• 1: Yes
• 2: No, supply shortages or rising prices did not impact my decision making
• 3: No, I had not planned any major non-essential purchases

Impacts of rising prices (IRP) - Question identifier:IRP_Q70

Thinking about the amount of stress in your life related to financial issues, how would you describe most of your days?

• 1: Not at all stressful
• 2: Not very stressful
• 3: A bit stressful
• 4: Quite a bit stressful
• 5: Extremely stressful

Impacts of rising prices (IRP) - Question identifier:IRP_Q80

In the past 6 months, have rising prices influenced your decision to participate more in any of the following activities?

• 1: Donating money or goods to community services (e.g., food banks, furniture or clothing donation, community service organizations, shelters)
• 2: Giving money or goods to other individuals or households who are struggling financially
• 3: Participating in fundraisers that assist individuals or households who are struggling financially
• 4: Volunteering formally for a community organization focused on poverty or community assistance (e.g., shelters, social services, food delivery for seniors)
• 5: Volunteering informally to help other individuals or households who are struggling financially (e.g., food delivery to a family member)
• 6: Offering professional services at no charge to other individuals or households who are struggling financially
• 7: I have not been influenced by rising prices to increase my participation in the activities above

Education (ED) - Question identifier:ED_Q05

What is the highest certificate, diploma or degree that you have completed?

• 1: Less than high school diploma or its equivalent
• 2: High school diploma or a high school equivalency certificate
• 3: Trades certificate or diploma
• 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
• 5: University certificate or diploma below the bachelor's level
• 6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.)
• 7: University certificate, diploma or degree above the bachelor's level

Sexual and reproductive health (SRH) - Question identifier:SRH_R01

The following questions are about access to sexual and reproductive health information. The questions relate to where people may get information and if they have discussed their sexual and reproductive health needs with a health care provider. The information provided will help inform guidelines, programs and policies.

Sexual and reproductive health (SRH) - Question identifier:SRH_Q01

Thinking about your time in elementary or high school, how helpful was your sex education in terms of preparing you for a healthy life?

• 1: Very helpful
• 2: Helpful
• 3: Unhelpful
• 4: Very unhelpful
• 5: Did not receive any sex education

Sexual and reproductive health (SRH) - Question identifier:SRH_Q02

How confident are you that you have the information you need to make healthy decisions about your sexual and reproductive health?

• 1: Very confident
• 2: Somewhat confident
• 3: Not very confident
• 4: Not confident at all

Sexual and reproductive health (SRH) - Question identifier:SRH_Q03

Where do you typically get information about sexual and reproductive health?

• 01: Health care providers such as doctors, nurses, psychiatrists, sex therapists or other health care providers (Include in-person or virtual)
• 02: Media, including Internet, television, radio or print
• 03: Friends
• 04: Family
• 05: Sexual partners
• 06: Telephone hotlines or live chats
• 07: Self-help groups (Include in-person or virtual)
• 08: Other sources
• 09: I do not get information from any source

Sexual and reproductive health (SRH) - Question identifier:SRH_Q04

Have you and any health care provider ever talked about any of the following topics?

• 1: Your sexuality
• 2: Your sexual history
• 3: Your sexual relationships
• 4: Your fertility
• 5: Birth control or pregnancy prevention
• 6: Sexually transmitted or blood borne infection prevention
• 7: I have not discussed any of these topics with a health care provider

Sexual and reproductive health (SRH) - Question identifier:SRH_Q05

Has discomfort talking about your sexual or reproductive health ever prevented you from getting help from a health care provider?

• 1: Yes
• 2: No

Marital status (MS) - Question identifier:MS_Q01

What is your marital status?

• 1: Married (For Quebec residents only, select the "Married" category if your marital status is "civil union".)
• 2: Living common law (Two people who live together as a couple but who are not legally married to each other.)
• 3: Never married and not living common law
• 4: Separated and not living common law
• 5: Divorced and not living common law
• 6: Widowed and not living common law

Language (LAN) - Question identifier:LAN_Q01

Can you speak English or French well enough to conduct a conversation?

• 1: English only
• 2: French only
• 3: Both English and French
• 4: Neither English nor French

Language (LAN) - Question identifier:LAN_Q02

What language do you currently speak most often at home?

• 1: English
• 2: French
• 3: Other

Indigenous identity (ABM) - Question identifier:ABM_Q01

Are you First Nations, Métis or Inuk (Inuit)?

• 1: No, not First Nations, Métis, or Inuk (Inuit)
• 2: Yes, First Nations (North American Indian)
• 3: Yes, Métis
• 4: Yes, Inuk (Inuit)

Sociodemographic characteristics (PG) - Question identifier:PG_Q05

The following question collects information in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.

• 01: White
• 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
• 03: Chinese
• 04: Black
• 05: Filipino
• 06: Arab
• 07: Latin American
• 08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
• 09: West Asian (e.g., Iranian, Afghan)
• 10: Korean
• 11: Japanese
• 12: Other

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q05A

Where were you born?

• 1: Born in Canada
• 2: Born outside Canada

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q05B

Are you a Canadian citizen?

• 1: Yes, a Canadian citizen by birth
• 2: Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted citizenship of Canada under the Citizenship Act.)
• 3: No, not a Canadian citizen

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q05C

Are you a landed immigrant or permanent resident?

• 1: No
• 2: Yes

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q10

In what year did you first become a landed immigrant or a permanent resident?

If exact year is not known, enter best estimate.

Year of immigration

Min = 0; Max = 9999

Long-term conditions (LTC) - Question identifier:LTC_R05

The following questions are about any long-term conditions you may have.

Long-term conditions (LTC) - Question identifier:LTC_Q05

Do you have any of the following difficulties?

• 1: Difficulty seeing even when wearing glasses or contact lenses
• 2: Difficulty hearing even when using a hearing aid or cochlear implant
• 3: Difficulty walking, using stairs, using your hands or fingers or doing other physical activities
• 4: Difficulty learning, remembering or concentrating
• 5: Emotional, psychological or mental health conditions (e.g., anxiety, depression, bipolar disorder, substance abuse, anorexia)
• 6: Other health problem or long-term condition that has lasted or is expected to last for six or more months
• 7: I do not have any difficulty or long-term condition that has lasted or is expected to last for six or more months

Long-term conditions (LTC) - Question identifier:LTC_Q10

Do you identify as a person with a disability?

• 1: Yes
• 2: No

Sexual orientation (SOR) - Question identifier:SOR_Q01

What is your sexual orientation?

• 1: Heterosexual (i.e., straight)
• 2: Lesbian or gay
• 3: Bisexual or pansexual
• 4: Or please specify

Total household income (THI) - Question identifier:THI_R01

Now a question about total household income.

Total household income (THI) - Question identifier:THI_Q01

What is your best estimate of your total household income by all household members, from all sources, before taxes and deductions, during the year ending December 31, 2023?

Rounded to the nearest CAN$

Min = -99999999; Max = 99999999

Total personal income (TPI) - Question identifier:TPI_R01

Now a question about total personal income.

Total personal income (TPI) - Question identifier:TPI_Q01

What is your best estimate of your total personal income, before taxes and deductions, from all sources during the year ending December 31, 2023?

Rounded to the nearest CAN$

Min = -99999999; Max = 99999999

Future surveys (UCE) - Question identifier:UCE_R05

Statistics Canada is planning a series of short, fifteen to twenty minute surveys about important social topics. These surveys will be sent out in the near future and will ask about a wide variety of issues that affect Canadian society. By participating in this survey series, you will be able to share your opinions and thoughts on these issues and compare your ideas with those of other Canadians.

Future surveys (UCE) - Question identifier:UCE_Q05

Would you like to sign-up for future surveys?

• 1: Yes
• 2: No (Note: Your household will remain eligible for other Statistics Canada surveys.)

Future surveys (UCE) - Question identifier:UCE_Q10A

Please provide the following information so we can email or text you to participate in this survey series.
Email address

Long Answer Length = 80

Future surveys (UCE) - Question identifier:UCE_Q10B

Please provide the following information so we can email or text you to participate in this survey series.
Cellular number

Long Answer Length = 10

Future surveys (UCE) - Question identifier:UCE_R15

Thank you for signing up. We will contact you soon.