Has Covid-19 affected your ability to be screened for colorectal cancer?

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* 1. In what state or U.S. territory do you live?

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* 2. Do you live in an urban, suburban, or rural area?

Urban

Suburban

Rural

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* 3. What age bracket are you?

Under 18

18-39

40-49

50-75

over 75

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* 4. Do you have a doctor or health system for your routine medical care?

Yes

Other (please specify)

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* 5. Do you currently have health insurance, or not?

Yes, I do

No, I do not

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* 6. Has the Covid-19 pandemic impacted your ability to see your health care provider? Some reasons might include mandatory social isolation, loss of insurance, reduced provider hours or access, or your health system cancelled your appointment.

Yes

Other (please specify)

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* 7. Given all the recent press about the passing of Chadwick Boseman, and information about screening for colorectal cancer, do you feel you are due for colorectal cancer screening right now?

Yes

Maybe

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* 8. If you answered YES or MAYBE to Q7, please select one or more reasons you think you need to be screened.

You are within the recommended age to be screened

You have some symptoms that concern you and you want to find out whether they might be caused by colorectal cancer

You have a close relative who has, or has had, colorectal cancer and you think you might be at increased risk

Other (please specify another possibly reason if your reason does not match those given)

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* 9. If you think you need to be screened for colorectal cancer, do you think Covid-19 or hearing about Chadwick Boseman has changed how you would be willing to be screened? Examples of ways to be screened include: stool-based tests for blood or DNA, virtual colonography, flexible sigmoidoscopy, or colonoscopy.

Yes

Other (please specify)

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* 10. Do you feel that your insurance will cover colorectal cancer screening?

Yes

Unsure (please specify)

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* 11. Do you think Covid-19 has delayed your screening for colorectal cancer?

Yes

Other (please specify)

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* 12. If you answered YES to Q11, please let us know how long this delay in screening for colorectal cancer has been.

0-2 months

2-4 months

4-6 months

6-9 months

9-12 months

more than 1 year

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* 13. If C4 has funds for new projects in 2021, what do you think we should focus on for the new year?

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* 14. This survey is anonymous and we sincerely appreciate you taking the time to complete it. However, if you would like to share your contact information for future communications directly from C4, please tell us how you would like to be contacted. We do not sell our contact lists, and only infrequently send out emails about upcoming events that may be of interest to you.

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Company

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