Sex* ----MaleFemale Any family history of cancer? (Yes/No) ---YesNo Education Level: ---UndergraduateGraduatePostgraduate Smoking Status: Current smoker Past smoker Never Smoker Drinking Status: Current drinker Drinking Frequency Monthly or less 2–4 times a month 2–3 times a week 4 or more times per week 6+ drinks on one occasion Never Less than monthly Monthly Weekly Daily or almost daily Past Drinker Never Drinker Symptoms (check all that apply) a) Sore throat ⁄ caught in throat b) Hoarseness ⁄ voice changes c) Lump on one side of mouth or cheek d) Lump in neck, behind ear, under jaw e) Numbness of tongue ⁄ other area f) Sore on lips for 2+ weeks g) Swelling causing dentures to fit poorly Oral cancer knowledge based questions: I think oral cancer can be prevented YesNo Oral cancer is a common cancer for Indian men YesNo Ever heard of oral cancer screening YesNo Ever been screened for oral cancer YesNo Ever seen or heard about free oral cancer screening YesNo Would you ever get screened? YesNo ----------------------------------------------------------------------------------------