COVID Impact Questionnaire

Getting access to healthcare has been difficult during the COVID-19 pandemic, and we'd like to learn more about your experience. By completing the short, 1-minute survey below, you'll be helping healthcare professionals understand the impact and better prepare to serve your needs in the future.

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* 1. What state do you reside in?

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* 2. Did you first notice your health concerns after Feb 27,2020?

Yes

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* 3. Did COVID-19 cause you to delay seeking help or initial appointment once you noticed your symptoms?

Yes

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* 4. Did you have difficulty obtaining necessary labs/imaging/biopsy during COVID?

Yes (less than 30 day delay)

Yes (between 31 and 60 day delay)

Yes (more than 60 day delay)

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* 5. Did you have difficulty obtaining appointment with an oncologist during COVID?

Yes (less than 30 day delay)

Yes (between 31 and 60 day delay)

Yes (more than 60 day delay)

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* 6. Did you postpone treatment due to concerns around COVID-19?

Yes (less than 30 days)

Yes (between 31-60 days)

Yes (more than 60 days)

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* 7. If you would like to be contacted about your experience, please provide your contact information below (optional):

Name

Email Address

Phone Number