Race, Ethnicity, Language, and Disability (REALD)

 

Please take a moment to answer our Race, Ethnicity, Language, and Disability questions. Your participation plays an important part in public health and helps us make sure that you and others receive the best possible care.
 

 
 
 
 
 
 

 

Race and Ethnicity

 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Language (Interpreters are available at no charge)

 
 

Skip to question 7 if you indicated English only

 
 
 
 
 
 

Skip to question 7 if you do not use a language other than English or sign language

 
 

 

Your answers will help us find health and service differences among people with and without functional difficulties. Your answers are confidential. (*Please select “don’t know” if you don’t know when you acquired this condition, or “don’t want to answer” if you don’t want to answer the question.)
 
 
 
 
 

Please stop now if you/the person is under age 5

 
 
 
 
 
 
 
 
 
 
 

Please stop now if you/the person is under age 15