1. Briefly list each type of cancer you've ever been diagnosed with:

2. Joining a health-space community will involve spending 12 weeks interacting with our professional facilitators and other cancer survivors. We encourage each community member to join our weekly 90-minute chat conversation, currently Wednesday evenings from 8pm to 9:30pm EST and to write a brief message about your experience with a weekly guidance exercise.

Are you interested in joining a weekly chat room with other cancer survivors and a health-space facilitator?	--- YES NO
Are you prepared to join the weekly chat room at some point during the next 12 weeks?	--- YES NO
Are you prepared to join the weekly chat room this week or next?	--- YES NO
If Wednesday evening from 8-9:30pm EST is a bad time for you, what other times might work?
Are you interested in responding to weekly guidance exercises provided by your healthspace facilitator?	--- YES NO
Are you prepared to respond to at least one guidance exercise at some point during the next 12 weeks?	--- YES NO
Are you prepared to respond to a guidance exercise this week or next?	--- YES NO

3. During the past week, how distressed have you been? Please click one of the circles next to the thermometer below.