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- Prefer to be anonymous*
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- What is the nature of your criminal record? (Check all that apply)*
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- Have you been denied any of the following due to your record? (Check all that apply)*
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- Which of the following have you been restricted from? (Check all that apply)*
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- Do you currently have a regular doctor or dentist you can see when needed?*
- What is the biggest barrier to accessing healthcare? (Select all that apply)
- Do you currently have access to mental health support?*
- What is the biggest barrier to accessing mental health care?
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- Should be Empty: