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You Can Help
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How much do you agree with the following statements? (1 = Strongly disagree; 5 = Strongly agree) I am confident in my ability to interpret blood and bone marrow biopsy test results.
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I know the benefit of getting a second opinion when needed.*
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5
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5
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3
4
5
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2
3
4
5
I know the information I need to convey to my care team to let them know what my treatment goals are.*
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2
3
4
5
I am confident in my ability to access information that will support an informed decision about treatment selection for my disease subtype.*
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2
3
4
5
How did you learn about this program? (Choose all that apply.)
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Korea, Republic of
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Paraguay
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Poland
Portugal
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Romania
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Saint Lucia
Saint Martin (French Part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch Part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
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Sweden
Switzerland
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Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-leste
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South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip*
I will be attending the Patient and Caregiver Summit*
Select An Option
I will be attending in person in Scottsdale.
I plan on participating virtually.
If attending in person, how many guests will you be bringing with you?
Select An Option
0
1
2
3
4 or more
My connection to myeloma is (I am a)*
Select An Option
Myeloma Patient
Myeloma Patient Caregiver
Myeloma Patient Family Member (non-caregiver)
Family/Friend of Deceased Myeloma Patient
Health Care Professional or Researcher
Biopharma, Medical Device, or Healthcare Technology Industry Professional
Other: Cancer Caregiver
My current myeloma status/the current myeloma status of the patient I know is:
Select An Option
MGUS/SMM
Newly Diagnosed
Remission/Response
Relapsed/Refractory
Not Sure
Not Applicable to Me
How much do you agree with the following statements? (1 = Strongly disagree; 5 = Strongly agree) I am confident in my ability to interpret blood and bone marrow biopsy test results.
Select An Option
1
2
3
4
5
I know the benefit of getting a second opinion when needed.*
Select An Option
1
2
3
4
5
I am familiar with the implications of high-risk disease and the tests that can define it.*
Select An Option
1
2
3
4
5
I am familiar with the standard of care for my disease subtype.*
Select An Option
1
2
3
4
5
I am aware that a clinical trial may be the best option for me, based on the specific disease subtype I have.*
Select An Option
1
2
3
4
5
I know the information I need to convey to my care team to let them know what my treatment goals are.*
Select An Option
1
2
3
4
5
I am confident in my ability to access information that will support an informed decision about treatment selection for my disease subtype.*
Select An Option
1
2
3
4
5
How did you learn about this program? (Choose all that apply.)
Email invitation
MMRF e-newsletter
CCAZ newsletter
Treatment center
MMRF website
CCAZ Website
Support group
Social media (eg, Facebook, Twitter)
Physician’s office
Word of mouth
Other:
Other: How did you learn about this program?
Submit Form
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