The Unicorn Foundation Patient Survey

Patient/carer information

Basic demographics of those who utilise the Unicorn Foundation resources

Question Title

* 1. Are you a patient, carer, family member etc?

Patient

Carer

Husband

Wife

Partner

Parent

Sibling

Friend

Other (please specify)

Question Title

* 2. What State or Territory does the patient live?

Australian Capital Territory (ACT)

Victoria (VIC)

New South Wales (NSW)

South Australia (SA)

Western Australia (WA)

Tasmania (TAS)

Northern Territory (NT)

Queensland (QLD)

Question Title

* 3. Does the patient reside in the metropolitan or rural area?

Metropolitan (within one hour drive of city centre)

Regional (over one hour drive from city centre)

Question Title

* 4. The patient's postcode?

Question Title

* 5. What is patient's sex?

Male

Female

Question Title

* 6. Which category below includes the patient's age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

Question Title

* 7. What is the a patient's primary diagnosis?

Neuroendocrine tumour of stomach

Neuroendocrine tumour of small bowel (duodenum, ileum, jejenum)

Neuroendocrine tumour of large bowel (appendix, caecum, colon)

Neuroendocrine tumour of the rectum

Neuroendocrine tumour of the pancreas

Neuroendocrine tumour of the bronchopulmonary tree (trachea, bronchus, lungs)

Neuroendocrine tumour of the testes or ovaries

Neuroendocrine tumour of unknown origin

Other (please specify)

Question Title

* 8. Has the primary tumour spread to other organs (metastasized) ?

Yes

Question Title

* 9. Is the patient managed by a multidisciplinary medical team?

Yes

Not sure