|
Questions marked with an asterisk (*) are mandatory.
Thank you very much for responding to this survey.
Your feedback will be used to help evaluate the
Survivorship Guide and aid us in the creation of future programs and resources for bone marrow/stem cell transplant survivors.
If you have any questions, please send them to
info@nbmtlink.org or call 800-546-5268.
| |
1
|
* Are you:
| Someone who has already had a transplant |
| A patient preparing for a transplant |
| A transplant caregiver (includes Spouses/Partners, Parents, Adult Children, Other Relative, or Close Friend) |
| A health professional |
| Other, please specify |
|
| |
2
|
| Male |
| Female |
| Decline to answer |
| |
3
|
Your age range:
| Under 18 |
| 18-35 |
| 36 to 50 |
| Over age 50 |
| Decline to answer |
| |
4
|
Your ethnicity:
| Hispanic or Latino |
| Not Hispanic or Latino |
| Decline to answer |
| |
5
|
Your race (Please select all that apply):
| White |
| Black or African American |
| American Indian or Alaska Native |
| Asian |
| Native Hawaiian or Other Pacific Islander |
| Decline to answer |
| |
Page 1 complete. Please click "submit" to continue.
| |
|
|