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* 1. First Name

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* 2. Last Name

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* 3. E-mail Address

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* 4. Confirm E-mail Address

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* 6. Please identify the type and location where your most recent cancer or the most recent cancer of a loved one was found.

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* 8. Please slide the bar to the number that best describes how much distress you have been feeling in the past week, including today.

No distress Extreme distress
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 9. Which of the following have you struggled with in the past week, including today? Select all that apply.

T