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TANICA Focus Group Pre-Registration
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Email
*
Your email
1. Eligibility Criteria: Are you a Native Hawaiian or Filipino breast cancer survivor?
*
Yes
No
2. First Name
*
Your answer
3. Last Name
*
Your answer
4. Phone Number
*
Your answer
5. Preferred method of contact (select all that apply)
*
Phone call
Text
Email
Other
Required
6. If you answered "other" above, please specify.
Your answer
7. Preferred day (select all that apply)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Required
8. Preferred time (select all that apply)
*
Morning (8AM-12PM)
Afternoon (12PM-4PM)
Early Evening (4PM-6PM)
Required
9. Food allergies/aversions/preferences
*
Your answer
10. Preference for focus group participation?
*
In-person
Virtual
11. How did you hear about the TANICA project?
*
Flyer
Facebook
Organization
Other:
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