Sexual Behavior and Health Survey

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The purpose of this survey is to explore sexual behavior and health. This survey is for exploratory purposes ONLY! All responses will remain completely anonymous.

This survey is for women only.

ONLY 2 QUESTIONS required. The rest are optional. Thank you very much!

The entire survey is 10 Questions, if you have time to fill out the whole thing, it would be very much appreciated.

* Required

Clarification for those who asked: If you are not currently in a relationship, you can answer using past relationships.

Have you ever been diagnosed with breast cancer? * *

Yes

No, but I had a benign tumor

Does your partner have acid reflux or a history of acid reflux? *

Yes

Unsure

What is your birthday?

YYYY

What is your gender?*

Male

Female

Clear selection

Which one or more of the following would you say is your race (select all that apply)?

White

Black or African American

American Indian or Alaska Native

Asian

Pacific Islander

Other

Unknown

What is your marital status?

Married

Divorced

Widowed

Separated

Never married

A member of an unmarried couple

Clear selection

What is the highest grade or year of school you completed?

Never attended school or only attended kindergarten

Grades 1 through 8 (Elementary)

Grades 9 through 11 (Some high school)

Grade 12 or GED (High school graduate)

College 1 year to 3 years (Some college or technical school)

College 4 years or more (College graduate)

Clear selection

If your partner has acid reflux, how often does it occur?

Very Often (more than once a week)

Often (more than once a month)

Occasionally (once a month or less)

Rarely (less than once every three months)

Never

Clear selection

Did any of your past sexual partners have acid reflux?

Yes

Unsure

Clear selection

If you can share the survey with 3 - 4 female friends who might be interested in taking it, it would be greatly appreciated. Here is a link to the survey https://forms.gle/zBCozmfx9HXya2aEA

Yes

Probably not

Clear selection

Are you open to answering 3 more personal question? We will explain why we are asking it, and it is completely anonymous.

Yes

Let me see the question first, and than I will decide

Clear selection

Clear form

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