Learn. Share. Take Action in Your Metastatic Prostate Cancer Journey.

Health Matters to Me – A Personal Priorities Survey

Health Matters to Me – A Personal Priorities Survey

Thanks for taking the “My Health Matters” survey.

By filling out this survey:

  • You will have a document that clearly outlines your prostate cancer health goals and priorities
  • You can share this document with your healthcare team and your family, so they know exactly what your health priorities are
  • Our website will provide recommended links to information that is specific to your needs and interests

The survey is 10 questions long and should only take a few minutes to complete.

LET'S BEGIN!

SUCCESS! You have completed the survey.

Now you can print or email your survey answers and share the results with your family and your healthcare practitioner to ensure your health matters are being heard and addressed.

Now you can print or email your survey answers and share the results with your loved one and his healthcare practitioner to ensure all of his priorities and needs are being met.

It is recommended that you retain a copy for your records as your answers will not be saved.

QUESTION

I am:

QUESTION

What is your top priority for your health?

QUESTION

Check the statement(s) that applies best to you.

Check all that apply:

QUESTION

Which activities are important for you to be able to continue?

Check all that apply:

QUESTION

Are you interested in finding a treatment for your prostate cancer?

QUESTION

If “YES”, what are your hopes that the treatment will be able to do?

Rank your responses:

QUESTION

What treatments have you tried already?

Check all that apply:

QUESTION

What are your primary concerns with trying a new treatment?

Check all that apply:

QUESTION

Do you wish you could spend more time talking to your physician or a nurse?

QUESTION

What kinds of health information would be helpful to you?

Check all that apply:

QUESTION

What is your loved one’s top priority for their health?

QUESTION

Check the statement(s) that applies best to your loved one.

Check all that apply:

QUESTION

Which activities are important for your loved one to be able to continue?

Check all that apply:

QUESTION

Are you or your loved one interested in finding a treatment for his prostate cancer?

QUESTION

If “YES”, what are the hopes that the treatment will be able to do?

Rank your responses:

QUESTION

What treatment has he tried already?

Check all that apply:

QUESTION

What are his concerns with trying a new treatment?

Check all that apply:

QUESTION

Do you or your loved one wish you could spend more time talking to the physician or nurse?

QUESTION

What kinds of health information would be helpful to you and your loved one?

Check all that apply: