Skip to content

Documentary Project on CLL Patients

CLL Patient Questionnaire

Passion Point Collective is casting 40-80 year olds who have been diagnosed and treated with CLL (chronic lymphocytic leukemia). Those selected to participate in the final project will be paid $100/hour for their time. If you have any issues with this form, please email gina@passionpointcollective.com.
During this survey, we will be asking you about your medical history/health as it relates to your diagnosis of CLL. Please select "I permit" below if you are willing to share information about your health as it relates to your diagnosis of disease for the purposes of recruiting for this project. This allows us to share your story with our brand client so that you can be considered.
1.By selecting one of the options below, you acknowledge that you have read and understand the above statement.
2.Full Name(Required.)
3.Email Address(Required.)
4.Phone Number(Required.)
5.What city + state do you live in? We are casting Nationwide, so please list city and state.(Required.)
6.Are you legally permitted to work in the United States?