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* 1. What is your postcode?

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* 2. Are you male or female?

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* 3. What is your email address? Leave blank if you would prefer not to disclose

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* 5. What hospital or health clinic do you go to for treatment or checkups related to your lymphoma?
If you are not attending a hospital or clinic, please type unknown.

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* 6. Do you have a local rural treatment centre that you have received treatment at?

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* 7. Select the most suitable option to describe your situation.
Are you currently:

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* 8. How far do you need to travel one way to see your lymphoma specialist?

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* 9. Have you used phone or video telehealth with your lymphoma specialist at any point?

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* 10. Did, or do you have a partner, friend or family member that you could rely on during treatment?

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* 11. How long ago were you diagnosed

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* 12. What supports were you offered at diagnosis? (select all that apply)

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* 13. When you were diagnosed did you find that your informational needs were met?

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* 14. When you were first diagnosed, did you look for more information on your lymphoma or its treatment, than what you got from the doctors and nurses caring for you?

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* 15. Have any of the following prevented you from receiving treatment? (select all that apply)

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* 16. Do you think your treatment options are different compared to someone with the same type of lymphoma living in a big city?

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* 17. In your own words, what has been your biggest challenge in managing your lymphoma or CLL while living regional, rural or remotely?

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* 18. Would you, or did you have to leave home for treatment and travel to big city hospitals?

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* 19. Have you been offered a clinical trial?

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* 20. Please select the option you would most likely choose, based on your personal choice and situation. 
When discussing treatment options, I would choose:

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* 21. How did you find out about Lymphoma Australia? (select all that apply)

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* 22. Do you consent to further contact from Lymphoma Australia, to help with further initiatives in the regional, rural and remote locations?

If you have further questions or require support, please contact our Lymphoma Australia nurse team
Email: nurse@lymphoma.org.au 
Phone: 1800 953 081

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