The Cancer Trauma Project Screening
This form must be completed before participating in the Cancer Trauma Project Interview. It ensures the basic stuff, like you have or have had cancer, that allows us to keep our information as organized as possible. It will take you less than 3 minutes!
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Email *
First and Last Name *
What is your phone number? *
What time zone are you in? *
How did you hear about the Cancer Trauma Project? *
Do you prefer to complete the interview questions in writing without talking to someone or would you prefer to have us call you? *
Are you over 18 *
Date of Birth *
If in the US, what is your zip code?
Can you read English well enough to understand and sign the release? *
Can you speak English well enough to understand and answer the interview questions? *
Do you currently have cancer or have you had cancer in the past? *
Have you had more than one cancer diagnosis? *
Do you believe your cancer experience was traumatic? *
Have you been diagnosed with Post Traumatic Stress Disorder (PTSD)? *
Have you received medical care at by the National Institutes of Health in Bethesda, MD in the past 30 days? *
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