Central Ohio Women's Health Pre-Survey

Thank you for choosing to participate in our research study.

We’re conducting a survey on behalf of a Central Ohio health system regarding women’s health services, and we want to hear from you. Please complete the short form below to see if you qualify. Submitting this form does not guarantee you will be selected.

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What is your ZIP code?*

What is your age?*

Which of the following best describes you?*

I am planning to have a child in the next 1–5 years

I have had a child and hope to have another

I am finished having children and/or receive regular women's health / GYN care

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Quiz Score

Thank you for choosing to participate in our research study.

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