Are You Prepared?
It’s important to have a plan in place in case of an emergency. Depending on the situation, it may be difficult to get the cancer care you need. Please take our survey and let Cancer Health know how prepared you are in the event of a disaster.
In general, how prepared are you to handle an emergency situation?
I’m ready for anything.
I’m somewhat prepared.
I’m not at all prepared.
Do you keep an emergency supply of all the medications that you take?
Yes
No
Do you keep an emergency supply of food and water in your home?
Yes
No
Do you keep a well-stocked and up-to-date first aid kit in your home?
Yes
No
Do you have an evacuation action plan in case of an emergency?
Yes
No
Have you shared your emergency plans with others?
Yes
No
Do you keep your emergency gear packed in an easy-to-carry bag or container?
Yes
No
Do you keep up-to-date hard copies of your medical and financial records in a safe place?
Yes
No
Do you keep up-to-date electronic copies of your medical and financial information?
Yes
No
Do you keep a copy of important phone numbers and passwords in a safe place?
Do you have a will?
Yes
No
Do you have an advance health care directive?
Yes
No
What year were you born?
2026
2025
2024
2023
2022
2021
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2019
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1930
1929
1928
1927
1926
What is your gender?
Male
Female
Transgender
Other
What is your current level of education?
Some high school
High school graduate
Some college
Bachelor’s degree or higher
What is your annual household income?
Less than $15,000
$15,000–$34,999
$35,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000 or more
What is your ethnicity? (Check all that apply.)
American Indian/Alaska Native
Arab/Middle Eastern
Asian
Black/African American
Hispanic/Latino
Native Hawaiian/Pacific Islander
White
Other
What is your ZIP code?
Please verify that you are human
*
Submit
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