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* 1. Which of the following best describes your profession?

* 2. Where are you located? (Please check all that apply.)

  Urban Suburban Rural
Large academic medical center
Community hospital/outpatient clinic
Private practice

* 3. What percent of your cancer patients are in their reproductive years (0-45)?

* 4. With what percent of these patients do you discuss cancer-related fertility risks?

* 5. Would you be willing to hang a poster about cancer-related infertility in your office or waiting room?

* 6. Which of the following options for poster content would be most useful to your colleagues?
Please rank the options below with 1 being the most useful and 4 being the least useful.

  1 (most useful) 2 3 4 (least useful)
When and how to discuss fertility preservation with your patients
Instructions on how to refer a patient to a fertility center or sperm bank
Information on fertility risks from cancer treatment
Chart on fertility preservation and parenthood after cancer options

* 7. Which of the following options for poster content would be most useful to your patients?
Please rank the options below with 1 being most useful and 3 being least useful.

  1 (most useful) 2 3 (least useful)
Information on fertility risks from cancer treatment
Chart on fertility preservation and parenthood after cancer options
Questions to ask your doctor about cancer and fertility

* 8. Who would be the best contact person at your center for distributing a poster about cancer and fertility?

Thank you for participating in our survey!

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