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* 1. CSC/GC Affiliate Where You Attended This Workshop

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* 2. Date of Workshop

Date

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* 3. Service Provider Name:

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* 4. Service Provider Function:

Participant Information

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* 5. I attended as a (check one):

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* 6. Cancer Type:

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* 7. Gender Identity (check one/write-in if comfortable):

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* 8. Age:

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* 9. Race/Ethnicity (check all that apply):

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* 10. 6. Highest Level of Education:

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* 11. Would you recommend this service to others?

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* 12. Would you use this service again?

Please select to what degree your experience aligns with the below statements:

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* 13. Please select to what degree your experience aligns with the below statements:

  1 - Strongly Disagree 2 - Disagree 3 - Neutral 4 - Agree 5 - Strongly Agree N/A
Handouts and/or visual aids were useful.
Services were appropriate to my needs.
Provider was knowledgeable of the topic.
I received advice on how to better manage my internal and/or visible side effects from cancer treatment.
Overall value of the service.

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* 14. Strengths, weaknesses, and other comments on the service and/or provider: 

0 of 14 answered
 

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