Are You Over 20 Years Old?

Whats Your Name ?

How Old Are You ?

30 - 39

40 - 49

50 - 59

Or Other

Is Your Family In Medica , If Is Which One Do They Have

Pollen

Heart Attack

Heart Disease

Other

Do You Work ?

Educational

Student

High school

Or Other

Are You In Disease?

What Do You Think About The Attack Of Dieases , What Do You Think ?

Do You Have Kids , If You Do , Are They Allregic To Things Ex: Pollen , Grass , Trees ?

Are You

When You Was 20 or higher How Did You Feel ?

Feel exitced

Feel Weird

Alittle Shy

Or Other

Thank You For Taking This Survey , How Did You Feel ?