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LLS Disease & Treatment Booklets Survey
Survey for Patients, Family and Friends
To help us improve our services, please tell us what you think about the booklet or fact sheet you read.
I am a
Patient or survivor
Caregiver/family member/friend
Healthcare Professional
Other (please specify)
Other (please specify)
What was the title of the booklet/fact sheet you read and are providing feedback about?
Please select the month and year shown on the back cover of the booklet (bottom right) or on the first or last page of the fact sheet (bottom right).
See examples, below.
Month
January
February
March
April
May
June
July
August
September
October
November
December
I can't find the date
Year
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
I can't find the date
Overall, how would you rate the booklet/fact sheet?
Very valuable
Valuable
Somewhat valuable
Not at all valuable
Was it easy to understand the information in the booklet/fact sheet?
Very easy
Easy
Somewhat easy
Not at all easy
After looking at the booklet/fact sheet, do you feel more confident managing your (or the patient’s) care?
Much more confident
Somewhat more confident
Stayed the same
Somewhat less confident
Much less confident
Did you experience any of the following problems with the booklet/fact sheet? (Select all that apply.)
I had difficulty reading the font
The font was too small
I had difficulty understanding the information
There was too much text
I had difficulty understanding the information because it was not in my primary language
I did not experience any problems
Other (describe)
Other (describe)
What was most helpful about the booklet/fact sheet?
Are there any topics or resources you would have liked the booklet/fact sheet to include that it did not?
Overall, is there anything else you want to share with us about the booklet/fact sheet?
Lastly, please tell us a little about yourself so that we can ensure our booklet/fact sheet is helpful to everyone.
When were you (or the patient) diagnosed with a blood cancer?
Less than 6 months ago
6 to 11 months ago
1 to 2 years ago
3 to 5 years ago
More than 5 years ago
Do you describe yourself as a man, woman, or in some other way?
Man
Woman
Some other way (please specify)
Some other way (please specify)
What is your age?
18 or under
19-29
30-39
40-49
50-64
65 or older
What is the highest level of school that you have completed?
8th grade or less
Some high school, but did not graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4-year college degree
Are you Hispanic or Latino?
Yes
No
What is your race? (You may choose more than one answer.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White or Caucasian
Other race (please specify)
Other race (please specify)
Are you currently receiving emails from LLS about services and resources that can provide support during treatment and survivorship?
Yes
No
If you would like to begin receiving email updates, please click submit, and then use the link on the following page to sign up.