Oregon Health-Related Research Screener

9. Race:

• White/Caucasian
• African-American/Black
• Hispanic/Latino
• Asian or Pacific Islander
• Middle Eastern
• Native American
• Other - Specify Please enter an 'other' value for this selection. * This question is required.

10. If you are enrolled in or are a descendant of an American Indian/Alaska Native tribe, please indicate the particular tribe/village/rancheria below.
 

• N/A
• Tribe/Village/Rancheria: Please enter an 'other' value for this selection.

10. Would you rate your overall health as excellent, very good, good, only fair, or poor? 
 

• Excellent
• Very Good
• Good
• Only fair
• Poor