FIND Questionnaire from GlobalCures
Version 5  
Sign in to Google to save your progress. Learn more
Email *
Who we are
GlobalCures is a non-profit medical research organization made up of scientists and doctors who have been personally affected by cancer and are committed to helping cancer patients. One of our missions is to disseminate information about safe, readily available, and inexpensive off-patent drugs and supplements that may extend survival and improve quality of life.

This questionnaire is part of the FIND program and it helps us to provide information about promising therapies. It is quite short and should take less than 15 minutes to complete.
Your information
Email address *
Birth year
Clear selection
The FIND Program *
By answering a few questions about your diagnosis, GlobalCures will provide you with a list of promising therapies and their supportive literature. Promising therapies are scientifically sound ideas for which there are limited human studies or data from animal research.
The SHARE Program *
The SHARE Program is a collective, patient-driven discovery effort. By donating your data, GlobalCures will be able to combine it with other patient shared data and analyze it to uncover novel ideas for therapies that can be tested formally in clinical trials.
Your disease
Type of cancer *
Stage of your cancer (if applicable)
Clear selection
Has the cancer spread to other organs?
Current treatment status
Clear selection
Are there known genetic mutations in your cancer?
If known, please describe.
Previous Treatments
Have you had surgery?
Have you received radiation treatment?
Clear selection
Have you received chemotherapy?
Clear selection
Have you received any targeted therapy?
Clear selection
Have you received any hormonal therapy?
Clear selection
Have you received any therapy recommendations? Please specify.
Medical History
Briefly summarize your medical history by checking the appropriate boxes
Current Performance Status
Describe your current level of activity
Clear selection
Patient's Notes
Provide any other relevant information regarding your treatments, blood tests, etc
Is there anything else you would like to share with GlobalCures?
The following information is for our records and lets us know if you wish to receive additional communications from GlobalCures
How did you hear about GlobalCures?
Referral's name
If you were referred to GlobalCures by a support community or an individual, please provide the name
Communications with GlobalCures
Would you like to receive future communications from GlobalCures, such as newsletters and announcements?
Clear selection
Clear form
Never submit passwords through Google Forms.
This form was created inside of GlobalCures. Report Abuse