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LAO Patient Feedback
This survey is for our patients. We kindly ask that you take the time to fill the feedback form out, so that we have a better idea of how we can support you. Your time and feedback is greatly appreciated.
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* Indicates required question
What is your name?
*
Your answer
What is your email address?
*
Your answer
Would you be interested in volunteering for our upcoming virtual fundraiser (August-September)?
*
Yes
No
Pathways Magazine - Do you want:
*
Paper
Online
Both
Do you enjoy reading the Pathways Magazine?
*
Yes
No
Due to an increase in operation costs, would you consider paying between $40-$50 for an annual membership?
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Yes
No
Do you use our Resource Guide?
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Yes
No
Do you attend our webinars?
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Yes
No
If you do not attend our webinars, please tell us why
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Timing doesn't work for me
Personally not interested in material
Technological issues
N/A, I attend the webinars
Other:
If you attend our webinars, would you be willing to pay up to $20 per webinar in order to facilitate a guest professional/speaker?
*
Yes
No
I don't attend the webinars
What type of Lymphedema do you have?
*
Primary
Secondary
If your lymphedema is secondary, what generated it?
*
Cancer treatment
Trauma related (accident, non-cancer surgery, etc)
Other
N/A, my Lymphedema is Primary
What part of your body is affected by Lymphedema? Please click all that apply.
*
Torso
Head/neck
Arms (including hands)
Legs (including feet)
Other
What is your gender?
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Male
Female
Prefer not to say
Would you be interested in volunteering on our Board of Directors?
*
Yes
No
If you have any feedback or suggestions for the LAO, please let us know below:
Your answer
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