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Q.1
Where in Lebanon do you currently reside? (City)
*
Q.2
How old were you when you were diagnosed with cancer?
*
Below 18
18-25
26-35
36-40
41-45
46-50
51-55
56-60
61-65
66-70
70+
Q.3
At what stage of the cancer were you diagnosed?
*
Stage 0: cancer in situ, which literally means “in place.” Stage 0 cancers are still located in the place they started and have not invaded nearby tissues. This stage of cancer is often highly curable, usually by removing the entire tumor with surgery.
Stage 1: a small cancer or tumor that has not grown deeply into nearby tissues and has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.
Stage 2 & 3: cancers or tumors that are larger in size, have grown more deeply into nearby tissue, and have spread to lymph nodes, but not to other parts of the body.
Stage 4: cancer has spread to other organs or parts of the body. It may also be called advanced or metastatic cancer.
Other:
Q.4
What type of cancer were you diagnosed with?
*
Bone
Breast
Cervical
Hodgkin's Disease
Leukemia
Lung
Ovarian
Skin
Stomach
Testicular
Liver
Other:
Q.5
At what stage in your cancer treatment are you currently in?
*
I was Recently Diagnosed
I'm Currently Undergoing Treatment (such as Chemotherapy or Radiotherapy)
I'm Completing Treatment (such as Hormonal Therapy)
I Completed Treatment Recently
I Completed Treatment a Few Years Ago
The cancer has returned.
Other:
Q.6
Are you covered by a Daman (Committee on National Security Systems) or similar program?
*
Yes
No
Other:
Q.7
Are you currently covered by an insurance company?
*
Yes
Yes, but with exclusions.
No
Other:
Feel free to elaborate (optional):
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