My Survivor Story
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| Your Name * |
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| Your Email Address * |
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| Phone |
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| PRIVACY - Tell us what information we can use about you: * |
Use all my information!
OK to use my first name and photo only.
OK to use my first name only.
Please keep my identity confidential.
Other:
Please check only one
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Your Story
Below are some probing questions for you to tell us your story. Feel free to complete as many or as few fields as you are comfortable.
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| How long have you been a cancer survivor? |
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| Tell the story of how you were diagnosed, emotions behind the diagnosis, first thoughts, etc. |
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| How did you decide what treatment was best for you? |
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| Was it a clinical trial? If so, did you have any preconceived notions about clinical trials that were either changed or enforced? If so, what were they? |
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| If you participated in a clinial trial, is there a reason why did you do so? |
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| If you DID NOT participate in a clinial trial, is there a reason(s) why did not? |
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| Describe your cancer journey – were there any rough or particularly scary moments? How did you cope? |
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| How were the treatments and side effects – worse or better than you anticipated? |
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| So what has life been like since your treatment? |
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| What life experiences do you believe you would have been missed if you had not undergone treatment? |
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| Any words of encouragement you want to share with others just starting their cancer journey? |
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| Anything else you want to share that has not been asked? |
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Photos You Want to Share
If you would like, please provide a few photos that we may use in our annual report. These can be you doing hobbys, or on vacation, or with family and loved ones, etc....the more personal, the better.
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| Photo 1: |
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| Photo 2: |
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| Photo 3: |
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