Stony Brook Cancer Center Community Needs Survey
Please take a few minutes to answer this short survey so that Stony Brook Medicine can work towards improving access to health care in your community. Thank you for your participation. (your answers will be anonymous).
1. What do you believe your current health status is? *
Required
2. What obstacles or barriers do you face in accessing health care? *
Required
3. What is your age? *
Required
4. Which gender do you identify as? *
Required
5. Please specify your ethnicity: *
Required
6. What language do you speak when you are at home? *
Required
7. What is your annual income from all sources? *
Required
8. What is the highest degree or level of school you have completed? *
If currently enrolled, highest degree received.
Required
9. What is your current employment status? *
Required
10. What is your 5 digit zip code? *
Your answer
11. Have you ever been told you have cancer? *
if Yes- Please answer questions 12 and 13, otherwise thank you for your participation.
Required
12. What type/s of cancer do/did you have?
13. What obstacles or barriers do you face in accessing cancer care?
Please an provide email so we can keep you updated. (optional)
Your answer
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