Project RADICAL Eligibility Survey

Question Title

* 1. What is your age?

18-24

25-39

40-64

65+

Question Title

* 2. What race/ethnicity do you consider yourself to be?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Some other race

Multiracial

Refused

Don't Know

Question Title

* 3. What was your sex at birth?

Male

Female

Don't know/Not sure

Refused

Question Title

* 4. What is the zip code where you currently live?

Question Title

* 5. Is your annual household income from all sources

Under $25,000

Between $25,000 and $50,000

Between $50,000 and $75,000

Over $75,000

Refused

Question Title

* 6. Select all that apply

I have metastatic lung cancer

I am a primary caregiver for a person with metastatic lung cancer

I am a primary care doctor who is working with Black/African Americans with lung cancer

I am an oncologist who is working with Black/African Americans with lung cancer

I am a community advocate for Black/African Americans living with lung cancer

Question Title

* 7. What type of insurance did you or the lung cancer patient you cared for have at diagnosis? (for patients and caregivers only)

Medicare

Medicaid

Private Health Insurance

Uninsured

Refused

Not applicable

Question Title

* 8. After your diagnosis were you or the lung cancer patient you cared for offered molecular testing? (for patients and caregivers only)

Yes

Not applicable

Question Title

* 9. Please enter your phone number and email address below. We will contact you if we determine that you qualify for this study.

Question Title

* 10. Please select all the time slots you are available for a study interview below.

April 5, 8 am - 9 am PST/ 11 am - 12 noon EST

April 7, 8am - 9 am PST/ 11 am - 12 noon EST

April 9, 8am - 9 am PST/ 11 am - 12 noon EST

April 12, 8am - 9 am PST/ 11 am - 12 noon EST

Thank you for completing our survey! A team member will reach out to you to coordinate an interview time in the next week.