Bag It Bag Feedback Form 2021
Your responses to this survey will be used to help us make the Bag It bag as useful as possible. In addition, our funders require us to provide them with data about who we serve and measure how effective the bag is.

We'd love feedback from both survivors and caregivers. If there is someone else in your circle who used the Bag It bag, please share this link with them.

Providing your name and email will allow us to enter you into our quarterly drawing for a gift card. You will be entered 1 time in the quarter your feedback was received.

*Please note Bag It will not share your contact information with other organizations.
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I am the: *
The contents of the Bag It bag helped me be more organized. *
Required
Please explain your answer:
The contents of the Bag It bag helped me cope better/worry less. *
Required
Please explain your answer:
The contents of the Bag It bag helped me feel more confident and comfortable speaking up for myself and asking questions of my healthcare team. *
Required
Please explain your answer:
Please mark the number from 1 (not at all helpful) to 5 (extremely helpful) that shows how helpful each booklet has been for you. *
1 Not at all helpful
2 Somewhat helpful
3 Helpful
4 Very helpful
5 Extremely helpful
I do not remember this booklet
Caring for the Caregiver
Heal Well
Paths to Survivorship
Taking Time
If you could add/change one thing in the bag what would it be?
Comments or anything you would like to share:
Today's Date
MM
/
DD
/
YYYY
Date of diagnosis
MM
/
DD
/
YYYY
Facility
First Name *
Last Name
Phone #
Mailing address
City *
State *
Zip Code
Email
You may use my responses: *
May we contact you for follow-up information? (Additional feedback, a written or video testimonial, as a potential speaker/story) *
Did you receive a cancer type specific bag? *
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