This questionnaire is only for UK or Ireland patients who have been referred to the Triana TRI-611 clinical trial.
It is expected that the TRIANA trial of TRI-611 will be open for several years and the Charity wishes to gather the real-world experiences of UK patients. If you have been referred for the trial, whether you have been accepted or not, we would be grateful if you could complete this questionnaire.

We will not share any personal information and any information that we publish will be anonymised. You can read our Privacy Notice HERE.

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1. Name (Required.)

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2. Email (Required.)

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3. Telephone

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4. When were you diagnosed with ALK-positive NSCLC?

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5. How many TKIs have you been prescribed? (Required.)

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6. Which TKIs have you been prescribed? (Required.)

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