Singles with Cancer Survey

1. i2y & Imerman Angels Survey. . .Singles with Cancer

On this page, we want to get your personal information (for follow up) and find out what were the biggest issues you dealt with during your cancer treatment. Please be as descriptive as possible.

1. Please share the following information with us so we may contact you in the future. In the company box, please tell us your age and what type of cancer you have/had. Thanks.

Please share the following information with us so we may contact you in the future. In the company box, please tell us your age and what type of cancer you have/had. Thanks. Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

2. Please check which issues you dealt with during and after your cancer treatment.

Please check which issues you dealt with during and after your cancer treatment. Feeling Alone

Wishing you had more support

Needing help because of physical limitations following surgery, chemo, radiation or other treatment

Not having anyone to go to doctor appts. or treatment with you

Body image issues because of scarring, weight gain, baldness

Concerns about fertility

Dating inadequacy or anxiety because of any of the above

Financial/Insurance issues

Work-related issues (vacation time, stigma, etc)

Other

3. Please comment on the issues above (or others not listed) to whatever extent you feel comfortable. How did they impact you and what still concerns you in regard to your experience with cancer as a single person?

Please comment on the issues above (or others not listed) to whatever extent you feel comfortable. How did they impact you and what still concerns you in regard to your experience with cancer as a single person?

4. What types of assistance were OR would have been helpful to you during or after your cancer treatment?

What types of assistance were OR would have been helpful to you during or after your cancer treatment? More information about treatment side and after effects

Support groups or retreats with other people my age

Other

A place to stay during treatment

Cleaning/Cooking

Connections with other similar cancer patients/survivors

Assistance navigating social services

Healing touch of some kind (reiki, massage, etc)

A patient advocate for communicating with my doctors

A book or other information about dealing with cancer as a single person

Fertility Options

Financial/Insurance assistance

A way to easily communicate with friends and family about my treatment and needs (website or other social media)

Rides to or companionship for treatment sessions

Dating/Sexuality Information

Education and/or career assistance

Child Care

5. Please share your top three needs from the above list or others, and describe in detail what services would have been most helpful to you during and after your treatment.

Please share your top three needs from the above list or others, and describe in detail what services would have been most helpful to you during and after your treatment.

Singles with CancerExit this survey

1. i2y & Imerman Angels Survey. . .Singles with Cancer

Singles with Cancer
Exit this survey