Get $15 to complete a survey

Please provide your contact information below so that we can send you a short survey. Everyone who completes that survey will receive a $15 Amazon gift card.

Your contact information will ONLY be used for the survey. You will not be contacted for any other reason.

Name*
First
Email*
Phone*
Which statement best describes your health insurance situation?*
- I do not have health insurance
- I get my health Insurance through an employer or union
- I purchase my health insurance independently (for example, directly from an insurer or through Nevada Health Link)
- I use Medicaid for my health insurance
- I use Medicare for my health insurance
- I am insured some other way.
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