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Support the American Lung Association
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Annual Patient & Caregiver Network Member Survey
*
Question - Required -
What member benefit do you find most valuable?
Please make between 1 and 6 selections from the choices below.
E-newsletters
Online Support Communities on Inspire.com
Mentorship program for lung cancer patients and caregivers in collaboration with our partner, Imerman Angels
Resource Center
Webinars
Other
Question - Not Required -
What other member benefit would you find valuable?
Please make between 1 and 6 selections from the choices below.
Support Mentor/Buddy
Discounts on American Lung Association Educational Programs/Special Events
Discounts to health and wellness products and services
Educational Series
Wellness Benefit
Other
*
Question - Required -
What types of resources would be helpful for a holistic wellness benefit?
Please make between 1 and 4 selections from the choices below.
One-on-one nutrition counseling
Quarterly webinar series
Nutrition handbook full of resources and helpful information
Other
*
Question - Required -
Have you visited the PCN Resource Center at https://lung.org/PCN-Resource-Center
Please select response
Yes
No
*
Question - Required -
Please specify which social media platforms you use to follow the American Lung Association
Please make between 1 and 5 selections from the choices below.
Facebook
X
Linkedin
Instagram
I do not use social media
Question - Not Required -
Would you like to share your Patient/Caregiver story? If you answer "Yes" to this question, be sure to provide your contact information below.
Please select response
Yes
No
*
Question - Required -
On a scale of 0-5 how likely are you to recommend the Patient & Caregiver Network to a friend or a colleague?
0 Not at all likely
1
2
3
4
5 Extremely likely
*
Question - Required -
Overall, how would you rate the quality of each of the following activities we engage in? Newsletter
1 the least favorable
2
3
4
5 Most favorable
Not Applicable
*
Question - Required -
Programs
1 the least favorable
2
3
4
5 Most favorable
Not Applicable
*
Question - Required -
Website
1 the least favorable
2
3
4
5 Most favorable
Not Applicable
Question - Not Required -
What types of educational programs or new resources would you like to see in the future, or how can we improve the Patient & Caregiver Network?
(Maximum response 255 chars, approx. 5 rows of text)
Question - Not Required -
The following questions align with the American Lung Association's commitment to diversity, equity and inclusion. These questions are optional and confidential. This information helps ensure that the Patient & Caregiver Network is accessible and relevant for everyone. What is your age?
Under 15 years old
16-24
25-34
35-44
45-64
65 years or older
Prefer not to say
Question - Not Required -
With which racial or ethnic group do you identify?
Hispanic or Latino
White
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
American Indian or Alaska Native
Two or More Races
Prefer not to answer
Are you a patient with lung disease or caregiver?
(Select one of the available choices or enter a different value.)
Question - Not Required -
Are you a patient with lung disease or caregiver? Click this to indicate that you will select an existing value. Tab to next input."
Are you a patient with lung disease or caregiver?
Please select response
Patient
Caregiver
Are you a patient with lung disease or caregiver? Click this to indicate that you will enter a new value. Tab to next input."
Are you a patient with lung disease or caregiver? Provide your answer here
Question - Not Required -
(Optional) Please provide your contact information (full name and email or phone number) if you would like to share your Patient/Caregiver story or in case we have follow-up questions to your survey responses.
(Maximum response 255 chars, approx. 5 rows of text)
Spam Control Text:
Please leave this field empty
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