Phone / Text

I want to be notified of upcoming events and 2Live2Cure survey opportunities. By entering my phone number I understand I may be called or texted for survey follow up or to be notified of upcoming events.

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Age *

Under 18

18-25

26-34

35-44

45-54

55-64

65-74

75+

Gender *

Male

Female

Non-Binary

Prefer not to say

Other

Ethnicity *

CHECK ALL THAT APPLY

American Indian

Black

Asian

White

Hispanic/Latino

Other Pacific Islander

Mixed Race

Prefer Not to Say

Other

Have you met with a social worker from your hospital? *

Yes

No

Unsure

How far do you travel for care each way? *

1-10 Miles

11-25 Miles

26-50 Miles

50-75 Miles

75-100 Miles

100+ Miles or More

How often do you travel for medical care? *

1 time per week

2 times per week

3 times per week

1 time per month

2-3 times per month

Is time a barrier to receiving care?

Yes

No

Sometimes

Are finances a barrier to receiving care?

Yes

No

Sometimes

How do you look for cancer patient resources?

I rely on my hospital oncology staff or social worker

I look online

I use social media

I rely on friends or family members

I would like more information on 2Live2Cure patient resources.

Have you been offered support services, care kits or resource information at your hospital?

Yes, from my social worker

Yes, from hospital resource boards/posters

Yes, I have received a care kit at my hospital

No, I have not been offered other resources at my hospital

No, I have not received a care kit at my hospital

What support services or programs do you currently use at your hospital? *

Exercise or Yoga Classes

Support Groups

Massage

Facials or Spa Services

Lymphedema Massage

Meal Services

Gym Privileges

Financial Aid Programs

None

Other

Since your cancer diagnosis, have you been able to participate in any personal wellness activities?

Yoga or Exercise Classes - (online)

Yoga or exercise classes - (in-person)

Nutritional Services - (online or tele-health)

Nutritional Services - (in-person at hospital or clinic)

Cancer support group meetings - (in-person)

Cancer support group meetings - (online)

Facials & Spa Services

Massage

Acupuncture

Chiropractic

Meditation

None

Other

Since your cancer diagnosis, have you made any changes to your lifestyle?

Yes

No

Some

Added exercise to my routine

Changed my eating/dietary habits

Changed work environment

Changed social activities

Do you feel like you have the support you need to manage your cancer care? *

Yes, I feel I have enough support managing my care.

I could use more support managing daily activities at home.

I would be interested in non-medical support services.

I would be interested in additional support services offered by my local clinic or hospital.

Would you be more or less likely to attend classes, support groups, or events if they were held online?

No, I would not be more inclined to attend events online

Yes, I would be more apt to attend events online

I like to attend these events in person

I would not like to attend additional events

What cancer support services would you like to see offered in your area? Check all that apply *

Yoga or Exercise Classes - (online)

Yoga or exercise classes - (in-person)

Art Classes

Music Classes

Meal Service - (delivered, meals on wheels, volunteer)

Meal Service - (pick-up from local restaurants or food hubs)

Facials & Spa Services

Massage Services

Cancer Patient Care Kit - (in-person at hospital or clinic)

Cancer Patient Care Kit - (mailed to your home)

Nutritional Services - (online or tele-health)

Nutritional Services - (in-person at hospital or clinic)

Cancer support group meetings - (in-person)

Cancer support group meetings - (online)

House Cleaning Services - (at home)

Day care during medical appointments

Financial aid services & foundation program information

Insurance guidance and services

State and federal program assistance

CBD information

Oregon Medical Marijuana Program information

At home social services available to cancer patients

Disability Adaptation - at home safety and accessibility retro-fitting

Fuel or Travel Support

Overnight Housing for long travel

Other

I would like to participate in future surveys to help guide the development of cancer support services in my area.

Yes

No

Maybe