Source water Wellness Survey: For people undergoing Chemotherapy or Radiation

We’ve had consistent feedback from customers, and now we’d like to gather structured input through a short survey. Your response will help support future research into our water. Thank you for taking the time to share your experience.

This 10-minute survey is for individuals who are currently undergoing, or have completed, chemotherapy and/or radiation treatment; whether for cancer, benign tumours, or other medical conditions. 

If you’ve also been drinking Source water during this time (or some of this time), we’d love to hear about your experience. 

Your responses are confidential and will help us understand how Source water may support others going through similar journeys.

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Section 1 – Treatment Overview
1. What type of cancer are you being treated for? *
2. Which treatment are you currently undergoing or have recently completed? (Select all that apply) *
Required
3. When did your most recent treatment begin? (Month/Year or approximate) *
4. Are you currently still in treatment? *
Section 2 – Symptom Tracking
5. If you WERE drinking Source water at the time of treatment:

Rate the severity of each symptom during your treatment(s). (0 = Not at all, 10 = Extremely severe) *
0
1
2
3
4
5
6
7
8
9
10
Nausea
Vomiting
Fatigue / Exhaustion
Pain / Discomfort
Hair loss
Brain fog or confusion
Depression / Anxiety
Mouth sores or dryness
Constipation / Diarrhea
Skin changes
Sleep disturbances
6. If you WERE NOT drinking Source water at the time of one or more Treatments : 

Rate the severity of each symptom. (0 = Not at all, 10 = Extremely severe)

(You can skip this section if you continued drinking Source water throughout every treatment)
0
1
2
3
4
5
6
7
8
9
10
Nausea
Vomiting
Fatigue / Exhaustion
Pain / Discomfort
Hair loss
Brain fog or confusion
Depression / Anxiety
Mouth sores or dryness
Constipation
Diarrhea
Skin changes
Sleep disturbances
Clear selection
7. Were you told by your medical team to expect these symptoms? *
8. Have you experienced any unexpected *absence* of symptoms you thought you would have?
Section 3 – Source Water Usage
9. How long have you been drinking Source water (or how long did you drink it during treatment)?
Please select the option that best reflects your usage.
 *
10. If you’re no longer drinking Source water, what was the reason?
11. On average, how much Source water did you drink per day during treatment? *
12. If treatment is complete, how much do you now drink per day?
13. During treatment period(s) how often do/did you drink Source water during the day? *
14. Have you ever run out of Source water during your treatment period? *
15. If yes, did you notice any changes during that time?
Section 4 – Perceived Effects of Source Water
16. Compared to your expectations, do you feel Source water has made any difference to the following? *
Much worse
Slightly worse
No change
Slightly improved
Greatly improved
Not experienced
Not applicable
Nausea or vomiting
Energy or vitality
Clarity of thinking
Emotional regulation
Skin or hair condition
Gut comfort
Pain or discomfort
Hydration
Immune support
Detox after Chemotherapy or Radiation
17. Have you experienced any unexpected benefits or positive effects that you associate with Source water?
Section 5 – Final Thoughts
18. Would you be open to us contacting you (confidentially) to learn more about your experience? *
19. If you answered Yes or Maybe above, please share your name and email address:
20. Is there anything else you’d like to share with us?
Submit
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