Survey Participation & Privacy Notice

This survey is being conducted by CBM to gather feedback on your healthcare experience. Your participation is entirely voluntary, and you may withdraw at any time without penalty.

As part of this survey, you may be asked to provide Personally Identifiable Information (PII) such as your name, contact number, email address, and city. This information will be kept confidential and used only by CBM for research purposes and, with your consent, to contact you for future surveys.

Your individual responses will be accessible only to the research team and will not be disclosed to any third party without your explicit consent, except as required by applicable law. All information collected will be stored securely in compliance with applicable U.S. privacy and data protection laws, including the Health Insurance Portability and Accountability Act (HIPAA), where applicable.

By proceeding with this survey, you acknowledge that you have read and understood this notice and voluntarily agree to participate.

Patient Screener Survey

Mesothelioma Cancer Research Study

Question 1 of 12

S10. In what year were you born?

Please enter a valid birth year between 1953 and 1998.
Question 2 of 11

S20. What is your gender?

Question 3 of 11

S30. Which of the following conditions have you been diagnosed with by a doctor?

Please select all that apply.
You must have Mesothelioma Cancer or Lung Cancer to participate in this study.
Question 4 of 11

S40. What type of symptoms do you face?

Please select all that apply.
Question 5 of 11

S50. Please describe about physical, emotional and well-being?

Including aspects like pain, sleep, appetite, and ability to perform daily activities.
Question 6 of 11

S60. What psychological Impact do you face?

Please select all that apply.
Question 7 of 11

S70. When were you diagnosed?

Based on your diagnosis timeframe, you are not eligible for this study.
Question 8 of 11

S80. Have you ever suffered any significant trauma to, on surgery?

Question 9 of 11

S90. How likely would you be to participate in Mesothelioma Cancer clinical trial if your doctor recommended it to you?

1
2
3
4
5
Not at all willing Extremely willing
Question 10 of 11

S100. How often do you see Oncologists (medical, surgical, and radiation), and potentially thoracic surgeons, pulmonologists, and palliative care specialists?

Question 11 of 12

S110. Which of the following best describes your ethnicity?

Question 12 of 12

S120. What is your marital status?

Thank you for your interest

Unfortunately, based on your responses, you do not qualify for this research study at this time.

We appreciate your time and consideration.

Survey Complete!

Thank you for completing the patient screener survey. Your responses have been recorded.

You Qualify for Mesothelioma compensation, Please proceed with the next steps to enroll for it!

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