Thank you for taking this assessment. By answering the questions below, a custom patient plan featuring a collection of vetted resources will be emailed to you within 5 minutes. If you don’t see it, please be sure to check your spam. Stay [ACT]IVATED.

1.What does it mean to be an ACTIVATED patient and/or care partner?

2.Do you incorporate wellness activities into your daily routine? 

Yes 

No 

Occasionally 

3.Do you experience any of the following treatment side effects?

Fatigue

Weight loss

Nausea and vomiting blood

Black stools

Abdominal bloating or pain

Difficulty swallowing

Severe indigestion

Changes in appetite

Not applicable

Other (please specify)

4.What other resources will help you as you navigate your care?

Insurance information 

Available treatment options 

Emotional well-being 

Social issues 

Dating and cancer 

Second opinions 

Connecting to support groups 

Clinical trials 

Testing

Financial toxicity

Patient stories

Nutrition information 

Exercise tips 

Care partners

Survivorship/Recurrence

I would like to share my journey with PEN

Other (please specify)

*5.Contact Information(Required.)

Name

Email Address *