PFBL2201| Screener Survey

Introduction
Bladder Cancer Canada is working with a pharmaceutical company to gain insights from Canadians diagnosed with advanced (metastatic) bladder cancer and better understand their personal experiences from the time of diagnosis and beyond.

We are hosting a virtual meeting on Friday, March 3rd, 2023 (1:00 pm - 4:00 pm) with a diverse group of individuals from across Canada who feel comfortable sharing their experience with advanced (metastatic) bladder cancer. The questions below will allow us to recruit participants with various backgrounds and experiences.

Thank you for your interest. If you have any questions about this survey, please contact Michelle Joannette (mjoannette@medplan.ca).

1. Do you live in Canada? *This question is required.

2. Have you ever been diagnosed with advanced (metastatic) bladder cancer? *This question is required.

2. When were you diagnosed with advanced (metastatic) bladder cancer? (month and year) *This question is required.

Month:
Year:

2. Are you currently participating in a clinical trial for bladder cancer? *This question is required.

2. What is your age? *This question is required.

2. What is your gender? *This question is required.

2. What is your cultural/ethnic background? Choose all that apply. *This question is required.

2. What is the highest degree or level of school you have completed? *This question is required.

2. How would you describe the community in which you live? *This question is required.

Please enter an 'other' value for this selection. * This question is required.

2. Please enter your name *This question is required.

2. Best means of contacting you (please provide information for at least 1 option below) *This question is required.

Please enter your phone and/or email

Note: Please make sure you have provided the right phone number and/or email in order for us to be able to communicate with you.

Phone number:
Email:

2. We will be conducting this meeting via Zoom with video. Do you have access to WiFi/internet to participate in the virtual meeting? *This question is required.

2. How comfortable are you with using a computer or tablet to participate in a virtual meeting? *This question is required.

Thank you for your interest.
This activity is only for individuals who live in Canada.

Thank you for your interest.
This activity is only for individuals who have been diagnosed with advanced (metastatic) bladder cancer.

Thank you for your interest. Unfortunately, we are unable to engage with individuals currently participating in a clinical trial.