1. What is the likelihood that you consider a Clinical Trial as a Treatment Option for your Cancer?

Not Likely Likely

2. Have you participated in a Clinical Trial for your Cancer in the Past?

Yes No

3. What best describes you?

Patient Care Giver Physician Other

4. Gender

Male Female Other

5. Age

<18 18-54 55-74 >74

6. Race

Black/African American White Native American/Native Alaskan Asian Pacific Islander Hispanic Other

7. Residence

Urban Suburban Rural

8. Household Income

<15,000 15-24,999 25-34,999 35-49,999 50-74,999 75-99,999 100-200,000 >200,000

9. Highest Level of Education Completed

Did Not Complete High School/GED High School/GED College Post Graduate

10. Insurance Coverage

No Insurance Medicaid Medicare Private/Employer Insurance Other

11. Internet Access

No Internet Access Use of Internet is Infrequent Commonly Use Internet