The Cancer Support Center Annual Survey
RequiredRequired Question(s)
1.
Please enter the information indicated below.

Postal Code:
Age:
Cancer Stage:
Cancer Type:
Ethnicity:
Gender:
Participant Type (Survivor, Caregiver, Bereaved):
Referred by:

2.
I have attended programs in the following areas:
Fitness & Physical Wellness (yoga, zumba, fitness workshops, massage, reiki)
Counseling & Stress Management (counseling & support groups, art therapy, sound bath )
Nutrition (individual consult, cooking demo)
Body Image (wigs, prosthetics)
Education & Networking (networking groups, special speakers & presentations)
Required 3.
Attending programs at The Cancer Support Center has improved my quality of life.
Strongly Disagree Disagree Neutral Agree Strongly Agree       
      
  • Comment:

  • 500 characters left.
4.

Have you utilized our phone, online and/or zoom programs?

Yes
No
Other  
  • Comment:

  • 500 characters left.
5.

If you have not accessed our programming during this pandemic, please tell us why? 

I do not have home internet access
I do not feel comfortable using the technology
I was not aware you were offering phone and virtual programming
I do not like to share my concerns virtually (phone or zoom)
It is not the same as coming to The Center
Other  
  • Comment:

  • 500 characters left.
6.
If you utilized our virtual and phone programs, how would you rate your experience? Please share why you chose that rating in the comments. 
Very Poor Poor Neutral Good Very Good       
      
  • Comment:

  • 500 characters left.
7.
When we re-open how will you access CSC services?
In-person Only
Online Only
Mix of both
Other  
  • Comment:

  • 500 characters left.
Please answer the following questions for any program areas you have attended. Your responses will help us better understand how our programs have impacted your quality of life. For each question mark all that apply. 
 
8.
Attending Fitness Classes (Yoga, Zumba, Fitness Workshops) has helped me:
Increase my energy level
Increase my ability to be active and go through my daily activities
Counter some treatment related side effects.
Cope with pain.
Other  
9.
Attending Physical Wellness programs (massage, reiki and/or cranio-sacral) has helped me:
Cope with pain
Decrease stress
Increase relaxation
Other  
10.
Attending counseling and/or group sessions has helped me:
To feel less sad regarding my illness or the illness of my loved one
To feel more hopeful about my illness or the illness of my loved one
To cope with my or my loved one's illness
Feel supported in my fight against my or my loved one's illness
Other  
11.
Attending stress management programs (art therapy, therapy dogs, sound bath) has helped me to: (check all that apply)
Decrease my overall level of stress
Better cope with my illness
To feel less nervous about my or my loved one's illness
Other  
12.
Attending nutrition programs (cooking demos and consults) has helped me:
Be mindful to eat healthier foods
Make changes to my daily eating habits
Better cope with digestive issues
Increase my energy level
Eating healthy has helped me feel active in fight against cancer
Other  
13.
Visiting the wig boutique/getting breast prosthetics helped me:
Increase my confidence
Participate in social situations
Come to terms with physical changes stemming from treatment
Other  
14.
Attending educational programs (special speakers and workshops) has helped me:
Learn new coping skills to help improve my quality of life
Feel more informed and active in my or my loved one's battle with cancer
Cope with worry related to my or my loved one's diagnosis.
Cope with treatment related side effects
Other  
15.
Attending networking groups has helped me:
To receive emotional support.
Learn more about my or my loved one's illness.
Feel less isolated in my or my loved one's battle with cancer.
Cope with treatment related side effects.
Other  
16.
What else can we do to improve  your quality of life?
 

350 characters left.
Thank you for your time.