CTCA Survey Card

Female

Male
I am:
How old are you:
Select One:  
I believe:  
I am more comfortable:  

Not
Sure

No

Yes
Do you think your current treatment plan is putting you
on the road to recovery?


No

Yes
Are you optimistic about beating cancer?
What type of cancer do you have?

What is the purpose of your visit to our website today?

No

Yes
Were you able to complete your task today?

If you were not able to complete your task today, why not?