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Living Now Special Issue: For Caregivers
3.
Please take a moment to give us your feedback
Please answer the following questions about this special caregiver issue of Living Now. We need your feedback to make our materials as helpful as possible.
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1.
Who reads the information in the newsletter? (Check all that apply)
(Required.)
Caregiver
Patient
Family
Friends
No one
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2.
Did you save this newsletter to read again?
(Required.)
Yes
No
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3.
Would you recommend Living Now to someone else in your situation?
(Required.)
Yes
No
Maybe
Don't know
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4.
Would you read Living Now online?
(Required.)
Yes
No
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5.
Would you be interested in receiving results of the Living Now survey?
(Required.)
No
Yes, by mail (please provide your full mailing address at the end of the survey).
Yes, by email. My email address is:
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6.
Are there other caregiver topics that you would like to have more information about?
(Required.)
No
Yes, please describe:
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7.
How useful were the following topic areas in the Living Now Caregiver newsletter you received?
(Required.)
Very useful
Useful
Not useful
Did not read
How transplant affects caregivers
Very useful
Useful
Not useful
Did not read
Taking care of yourself
Very useful
Useful
Not useful
Did not read
Getting help from others
Very useful
Useful
Not useful
Did not read
Dealing with emotional issues
Very useful
Useful
Not useful
Did not read
The caregiver’s responsibility
Very useful
Useful
Not useful
Did not read
The benefits of being a caregiver
Very useful
Useful
Not useful
Did not read
Post-transplant resources
Very useful
Useful
Not useful
Did not read
Caregiver photos/quotes
Very useful
Useful
Not useful
Did not read
For the following questions, please tell us about yourself. The information provided helps us understand your needs. All answers are confidential.
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8.
Caregiver is:
(Required.)
Male
Female
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9.
Caregiver’s age:
(Required.)
Under 18 years
18-25 years
26-49 years
50 years and older
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10.
Caregiver’s ethnicity:
(Required.)
Hispanic or Latino
Not Hispanic or Latino
Decline to answer
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11.
Caregiver’s race (Check all that apply):
(Required.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Don't know
Decline to answer
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12.
Caregiver’s highest level of education:
(Required.)
High School diploma
Associate degree
Undergraduate or Bachelor degree
Graduate or Doctoral degree
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13.
Would you recommend the Office of Patient Advocacy to others in your situation?
(Required.)
Yes
Not sure
No
Other (please specify)
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14.
Are you interested in sharing your post-transplant experience with other patients and caregivers?
(Required.)
No, not at this time.
Yes, please send me the transplant journey questionnaire. Provide contact information, including full mailing address, phone number and email address, below: