Clinical Trials Post Learning Survey

Earn a $20 Visa Gift Card

Attendees will recieve via mail a $20 Visa Gift Card upon completion of both the pre-learning survey and post-learning survey. Address will be collected in both pre and post survey. Please note, address is for mailing purposes only and will not be shared to any third party.

Prostate Cancer Clinical Trials Rally Post Learning Session Survey

Personal Information

Please provide the information so we may mail your $20 Visa Gift Card to you. Please note that this information will not be shared. Submittal of both pre and post survey required to receive gift card.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Post Learning Session(s) Evaluation

Have you been diagnosed with prostate cancer?

Yes

Unsure

How satisified were you with the clinical trial learning session?

Very Satisfied

Satisfied

Unsatisfied

Did the learning session increase your understanding of the clinical trials process.

Yes

Do you understand the role of the clinical trial site?

Yes

Are you satisfied with the safety of clinical trial participation?

Yes

Somewhat

How satisfied were you with the speaker's review of the clinical trials?

Very Satisfied

Satisfied

Unsatisfied

Were the speakers' presentation of clinical trials clear?

Yes

Somewhat

Have you been presented with an option to participate in a clinical trial before?

Yes

If yes, how do you rate your experience today?

Better

Same

Worse

How did the learning session influence your perception of the clinical trial site?

Positive

Unchanged

Negative

How likely are you to recommend these videos to other patients?

Highly Likely

Likely

Unlikely

Clinical Trials Interests

What would be the most important for you to consider participating in a clinical trial? (Select your top three answers)

An effective treatment or diagnostic option for myself

Minimal potential side effects

To contribute important information to medical science

Trial location relative to my home

Time required and schedule flexibility

Reputation of the clinical trial site

Family acceptance and support

What would you look for in a clinical trial research team? (select your top three answers)

Staff who takes the needed time to explain the study procedures to me including the risks and benefits

Staff members were well prepared for my visit

Being extremely satisfied with how the staff treated me

Being confident in the skills and knowledge of the staff

Staff responds quickly and fully to my concerns

Please rate the following:

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I am informed of the potential benefits of participating in a clinical trial study.
I am informed of the potential risks of participating in a clinical trial study.
I am confident in receiving treatment options in clinical trial studies.
I am confident in participating in a clinical trial study.
I am willing to participate in a clinical trial study.
Participating in a clinical trial study is an opportunity to have access to new, better treatments.
I will encourage family and friends to participate in clinical trial studies.

What clinical trial interested you?

AMG 509 (Immunotherapy)

Libertas (Hormonal)

CAPTCHA

Earn a $20 Visa Gift Card

Prostate Cancer Clinical Trials Rally Post Learning Session Survey

Personal Information

Post Learning Session(s) Evaluation

Clinical Trials Interests

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