Questionnaire

1) Name 2) Specify your Gender:- Male Female

3) Which age group do you belong to? 10 – 15 15 – 18 18 – 25 25 – 35 35 – 45 45 – 55 55 – 75 Above – 75 4) What is you occupation? Employment Student Others (Specify)__________________ 5) What is your family income? 20k – 40k 40k – 80k 80k – 1lac 1lac – 3lac 3lac – 5lac Above – 5lac 6) What is your regular source of medical care? Kemo Therapy Radio Therapy Pyramid Therapy Personal Doctor

7) Do you currently have medical care coverage(Insurance)? Yes No 8) Do any one of your family have health card? Yes No 9) How satisfied are you with the skill of competency with the staff? Very satisfied Somewhat satisfied Neutral Somewhat dissatisfied Very dissatisfied 10) Are you aware of the following modern treatment : Key hole treatment Radio therapy Kemo therapy Laser treatment Others (Specify)______________________ 11) How do you fell the hospitals using modern treatment techniques to cure cancer? 1) Fear Very scared _ _ _ _ _ _ _ _ Not scared 2) Risk Very Risk _ _ _ _ _ _ _ _ _ Not risk 3) Reliability More Reliable _ _ _ _ _ _ _ _ Unreliable 4) Cost Very Expensive _ _ _ _ _ _ _ _ _ Less expensive 5) Change of recovery High chance of recovery _ _ _ _ _ _ _ _ Less chance of Recovery .

12) Do you think any side effects in any cancer treatment(therapy)? Yes No Don't know 13) How do you feel the consumption of medicine after the cancer treatment? Increased considerably Slightly increased Slightly decreased Decreased considerably Don't know 14) How many cycles do you take in kemotherapy? 2 Cycles 3 Cycles 6 Cycles 8 Cycles 12 Cycles 15 Cycles 15) Are you sure about this cancer medicine they may recover you? Scared Confident Confident but still doubt about side effects 16) Is their any other person who is suffering from cancer? Family Relations Friends Colleagues 17) Is their any hereditary in your family or relations effected by cancer? Yes No 18) Is this drugs is capable to fight with cancer? Yes No 19) Are you getting treatment by your own money? Yes No 20) Are you satisfied with the drugs? Yes No .

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