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CRBS Feedback
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* Indicates required question
How are you impacted by RB?
*
Survivor
Family member of a survivor
Family member of a patient in active treatment
Friend of a survivor
Clinician/researcher
Other:
Required
How old are you?
*
19 and under
20-29
30-39
40-49
50 and above
What country do you live in?
*
Your answer
Province/state
Your answer
City
Your answer
What would you like to see from CRBS?
*
Community Zoom calls
In person events, such as family days
Guest speakers
Fundraising events
Advocacy in the community
Other:
Required
What topics would you like to know more about from guest speakers?
*
Children’s wellness during and after treatment (mental health support, infant massage, supporting siblings)
Prosthetic care
Genetics (latest information, family planning)
Survivorship (staying healthy, mental health, self advocacy, relationships)
Parenting support
Latest news on treatment options
Other:
Required
Who would you like to hear from?
*
Doctors
Nurses
Ocularists
Parents of survivors
Parents of children in active treatment
Survivors
Siblings of survivors
Siblings of patients in active treatment
Friends/other family members/spouses of survivors
Other:
Required
Would you be interested in volunteering with CRBS?
*
Yes
No
If yes, in what area?
Fundraising
Social media
Event planning
Community programming
Email Address
Your answer
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