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  • I agree to let The Duke Clinical Research Institute to collect only my zip code and no other identifiable information.
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  • Date of Sociodemographic Data Collection
  • What is your race? Mark one or more boxes AND print origins.
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  • Are you of Hispanic, Latino, or Spanish origin?
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  • Age For babies less than 1 year old, do not write the age in months. Write 0 as the age.
  • What was your sex assigned at birth?
  • What terms best express how you describe your gender identity?
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