Are you a current patient or family member of BC Cancer, Vancouver?
Patient
Family Member
Other:
What is the primary type of cancer or blood disorder you/your family member are being treated for?
What is the purpose of your visit to the centre today?
Select:
Clinic Appointment: Radiation
Clinic Appointment: Systemic/Chemo
Clinic Appointment: Other
Chemotherapy/Systemic Treatment
Pharmacy Appointment
Radiation Treatment
Other:
Data collected by this questionnaire will be used for the purposes of providing care, quality assurance, research, education and improving care at BC Cancer. Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose unless you expressly consent otherwise.
We do not disclose your information to other public bodies or individuals except as authorized by the FOIPP Act. For questions/concerns about the information collected and its use please contact VC Admin, 600 West 10th Ave, Vancouver, B.C. V5Z 4E6, 604-877-6000”