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* 1. Age

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* 2. Ethnic group you identify with:

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* 3. What is your gender?

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* 4. Type of cancer diagnosis OR please let us know your role if you are not a patient:

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* 5. Please check all of the in-person support groups that you would have interest in attending:

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* 6. Would you have interest in one-on-one peer support from an individual that has had a similar cancer diagnosis as you?

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* 7. How likely are you to attend an in-person support group that focuses on coping with parenting and/or managing professional responsibilities while undergoing cancer treatment regardless of diagnosis?

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* 8. Are there any groups, services, or activities that you would like to see Canopy offer that are not currently offered?

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* 9. What factors make it difficult for you to attend a group or class at Canopy?

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* 10. Is there anything Canopy can do to address any of these factors to increase your likelihood of being able to attend a group or class?

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