Feedback

Feedback Form

We are very interested in learning about your experience using the PACT website, and would appreciate receiving your feedback. We hope to hear from you regarding what you have found to be helpful, as well as what additional information might be useful. Please fill out the form below to provide us with your valuable input.

Name
Email
*City		*State

Would you like us to use the above e-mail address to contact you with newsletters, research initiatives, and other news/events?
Yes No

*1. HOW DID YOU FIND THE PACT WEBSITE?

Family Member/Friend
Health Care Professional
Mass. General Hospital Cancer Center Website
Search Engine (Google, Yahoo, etc.)
Support Service (group, therapy, etc.)
Other Professional
Paper flyers
Other Media (TV, magazine, newspaper, etc.)

*2. WHAT IS YOUR REASON FOR VISITING THIS SITE?

I am a parent with illness
I am a grandparent of a child with an ill parent
I am a partner/co-parent with an ill parent
I am a professional treating ill parents
Other

3. IF A PROFESSIONAL, WHAT DISCIPLINE ARE YOU IN?

Administration
Nursing
Oncology
Psychiatry
Psychology
Other Physician
Social Work
Clergy
Teacher
Other

4. DO YOU RECEIVE CARE OR WORK AT A HOSPITAL/FACILITY?

Yes No
Please tell us the name of the facility

*5. Of the following types of EMOTIONAL SUPPORT/CARE, please tell us which are AVAILABLE to you, which you have USED (or for professionals, which you usually RECOMMEND), and HOW HELPFUL each has been (Not Helpful – 1, 2, 3, 4, 5 – Very Helpful)

	Available	Used / recommend	How Helpful
Support Groups			1 2 3 4 5
Individual Counseling / Therapy			1 2 3 4 5
Parenting Guidance			1 2 3 4 5
Family Meetings / Therapy			1 2 3 4 5
Books / Literature			1 2 3 4 5
Websites			1 2 3 4 5
Blogs / Chat rooms			1 2 3 4 5
Religious / Spiritual Supports			1 2 3 4 5
Medicines			1 2 3 4 5
Herbal Therapies			1 2 3 4 5
None of the above are available to me

6. ARE THERE ADDITONAL TYPES OF SUPPORTS YOU WOULD LIKE, BUT ARE NOT AVAILABLE TO YOU?

*7. WHAT WERE YOU HOPING TO READ ABOUT IN THE PACT WEBSITE?

8. WAS THERE ANY SUBJECT NOT COVERED THAT YOU’D BE INTERESTED IN LEARNING MORE ABOUT?

*9. HOW EASY DID YOU FIND THIS WEBSITE TO NAVIGATE?

1	2	3	4	5
Very Difficult		About Average		Very Easy

If difficult, please tell us why:

*10. HOW USEFUL DID YOU FIND THIS WEBSITE:

1	2	3	4	5
Not Useful		Somewhat Useful		Very Useful

*11. HOW LIKELY ARE YOU TO RETURN TO THIS WEBSITE?

1	2	3	4	5
Not Likely		Might Return		Very Likely

*12. WOULD YOU RECOMMEND THIS SITE TO OTHER PARENTS OR PROFESSIONALS:

Yes No

* Required