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Colon Cancer Awareness
:
Colon Cancer Awareness Survey
Colon Cancer Awareness Survey
13WHAM News and the URMC care about your health.
Over the past month, we had a colon cancer awareness campaign to help educate and inform our viewers. Please take the time to fill out a brief survey. It’s only nine questions and your personal information will be kept confidential.
Survey Questions
1.
What is your gender?
Female
Male
2.
What is your Age Group?
40 or younger
41 to 50
51 to 60
61 or older
3.
Have you seen or heard any ads or public service announcements related to colon cancer awareness in the past 3 weeks?
Yes
No
4.
Have you already gotten a colonoscopy or plan to get one when you turn 50?
I have already had a colonoscopy
I plan on getting a colonoscopy
No
5.
Did the announcement(s) move you to talk with someone about the need for a colonoscopy?
Yes
No
I have not seen or heard the ads
6.
Was the conversation about the colonoscopy for your benefit or someone else’s?
Self
A Parent
A Spouse
Other
This does not apply to me.
7.
Did you call a primary care doctor?
Yes
No
This does not apply to me.
8.
Did you call a specialist (i.e. GI, surgeon, etc.)?
Yes
No
This does not apply to me.
9.
Did you call a cancer center?
Yes
No
This does not apply to me.
Contact Information
(to contact you in the event you win one of our random drawings)
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E-mail
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