State your race and ethnicity, or no doctor for you. The image below was sent to me by a reader who went for a visit to a physician, and was told that she could not be seen unless she filled out this race and ethnicity questionnaire, and put her name on the form. She initially refused, but they insisted that it was required or she could not see the doctor. The form does indicate that it is mandatory under Section 4302 of Obamacare.