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Your feedback about the 7th edition of the Cancer Resources Guide is extremely important to the Northeast Regional Cancer Institute. Please take a couple of minutes to complete this survey. When you submit your completed survey you will be entered into the Cancer Institute quarterly drawing for a chance to win a gift certificate from a local businesses in Northeastern Pennsylvania.
 
Cancer Resources Guide Survey
1. Where did you get your copy of the Cancer Resources Guide?
2. How useful is the Cancer Resources Guide?
1.     2.     3.     4.     5.
Not Useful                         Very Useful
3. Did the Cancer Resources Guide increase your awareness of cancer-related resources?
Yes No
4. How useful is the Cancer Resources Guide to manage a cancer diagnosis?
1.     2.     3.     4.     5.
Not Useful                         Very Useful
5. What did you feel was most useful?
6. What did you feel was least useful?
7. Have you accessed the Cancer Resources Guide from the Cancer Institute website ( www.cancernepa.org )?
Yes No
8. Are you a cancer survivor, caregiver or healthcare provider?
Survivor    Caregiver   Healthcare Provider
9. Age (optional)                               
10. Zip Code (optional)   
11. E-mail address (optional)  
To enter into the Cancer Institute drawing please provide
 

Thank you for taking the time to
fill out our survey.
We appreciate your comments
in our effort to better serve our
communities.
Name:
Address:
 

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