Demographics

Please describe how you have experienced melanoma. If you are the parent or caregiver of a patient who has experienced melanoma and are responding for or with the patient, please answer the survey to describe the patient’s experience

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* 1. What type of melanoma were you diagnosed with?

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* 2. At diagnosis, what was your melanoma stage?

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* 3. What is your current melanoma stage?

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* 5. Please list your city and state/province/region.

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* 6. What is your sex?

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* 7. What age group are you in?

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* 8. What is the highest grade level in school you completed?

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* 9. What ancestry describes you? (Select all that apply)

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* 10. For those not living in the USA: where do you seek health care?

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* 11. How do you pay for health services? (Select all that apply)

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* 12. Insurance paid/pays for what percentage of the following melanoma services?

  0% 1-25% 26-50% 51-75% 76-99% 100% Not applicable-did not need this service
Biopsy
Laboratory tests
Surgery
Radiotherapy
Intravenous chemotherapy/immunotherapy
Oral chemotherapy/targeted therapy
Physical care services (eg: physical therapy, lymphedema care)
Psychosocial health services
Symptom management/palliative care
Hospice/end-of-life care

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* 13. I worry about the financial problems I will have in the future as a result of my illness or treatment.

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* 14. My cancer or treatment has reduced my satisfaction with my present financial situation.

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