Pancreatic Cancer MR

We are a branch of a larger market research company, whose goal is to make contact with as many people diagnosed or caregiver in the treatment of Pancreatic Cancer. We will be looking to reach out to those who show interest in the form of online surveys and telephone discussions to understand the needs of patients.

All information collected during the surveys or phone discussions are completely confidential in that your name or other identifying information will not be shown to our clients.

Question Title

* 1. Which of the following best describes you:

I have personally been diagnosed with Pancreatic Cancer by a physician

I am a caregiver of an individual diagnosed with Pancreatic Cancer

Question Title

* 2. Patient age?

AGE

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* 3. The current stage of Pancreatic Cancer is:

III

Comment?

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* 4. Which of the following treatments have you/patient initiated?

Surgery

Radiation

Chemotherapy

Targeted Therapy

Comment?

Question Title

* 5. Please provide contact information. Name & Phone are not required but requested.

Name:

ZIP: *

Email Address: *

Phone Number:

Thank you very much for taking the time to fill out this short questionnaire. We are collecting basic information to match individuals with specific survey requirements in order to invite qualified participation