Questionnaire Text

Questionnaire form view entire document: text image

2. Gender

[] 1 Male
[] 2 Female

5.a. Marital status

[] 1 Single
[] 2 Married
[] 3 Widowed
[] 4 Divorced

Questionnaire instructions view entire document: text image

2. Sex:

[] 1 Male
[] 2 Female

5a. Marital status:

[] 1 Single
[] 2 Married
[] 3 Widowed
[] 4 Divorced