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Survivor Story Submission
Name (or alias)
Gender
Female
Male
Age at Diagnosis
Current Age
Type of Cancer
Cancer Treatment Received
Relationship Status at Diagnosis
Current Relationship Status
Were you a parent at time of diagnosis?
Fertility preservation and fertility support services are important to me because:
At time of diagnosis, did you know that cancer treatment could affect your fertility?
Do you feel you received adequate information and/or support regarding fertility risks associated with cancer treatment and fertility preservation upon your diagnosis? Why or why not?
If you were not already aware, how did you feel after learning about the possibility of cancer-related infertility?
Briefly describe your life prior to your diagnosis (work, education, family, location):
Did your diagnosis change your life or alter your plans for the future?
How did your diagnosis impact your desires to become a parent in the future?
If you did undergo fertility preservation, please briefly describe your experience.
Have you become a parent post cancer treatment?
What advice would you give newly diagnosed cancer patients who are facing the possibility of infertility?
If you would like to add any additional information please do so here:
How did you hear about Fertile Future?
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