SurveyMonkey Powered Online Survey

CANCER101 Planner Survey

Tell us about your experience with the C101 Planner, "Roadmap to Wellness"! Pay it forward and help us improve the planner for others diagnosed with cancer and their families. You will be entered into a drawing to receive a $25 Amazon gift card for completing this survey. Care/support partners are also more than welcome to submit survey responses!

DEMOGRAPHIC INFORMATION

Question Title

* I am a:

Person diagnosed with cancer

Care/Support Partner (Caregiver)

Other

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* Age Range: What generation do you affiliate with?

Silent Generation: Born 1945 and before

Baby Boomer: Born 1946 – 1964

Generation X: Born 1965 – 1976

Millennial: Born 1977 – 1995

Gen Z: Born 1996 or after

Don’t wish to share

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* Gender Identity

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* Postal/Zip Code

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* Where did you receive your planner?

My Hospital/Doctor’s office

Ordered online

Received from a friend/family member

Other

CANCER101 Planner Survey

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* I am a:

Question Title

* Age Range: What generation do you affiliate with?

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* Gender Identity

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* Postal/Zip Code

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* Where did you receive your planner?

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* If you received from your doctor/hospital, please provide their name and contact information (if available).