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SIOPE Survey 2016-2017
Contact Information
1.
Surname and Name:
2.
Country:
3.
Institition or Paediatric Haematology-Oncology Society/Group
4.
E-Mail:
5.
Profession
Paediatric Oncologist / Haematologist (please indicate your specialty in the field "Other")
Paediatrician
Oncologist
Paediatric Nurse
Psychologist - Psycho-social Support Specialist
Radiation Oncologist
Radiologist
Surgeon
Epidemiologist
Researcher / University Professor / Lecturer
Adult Oncologist / Haematologist
Parent / Patient / Survivor Advocate
Other (please specify)
6.
Age
18 - 29
30 - 44
45 - 59
60+
7.
Gender
Female
Male
*
8.
Are you member of SIOPE?
(Required.)
Yes
No
