Brain Tumor Drug Copayment Assistance Program

Copayment Assistance Program Survey!

This is annonymous, but if you would like a response, fill out our feedback form!

 Are you a: Brain Tumor Patient
Patient Advocate
Other (Explain in last comment box)
 Did you (or your patient) receive a grant from us? Yes
No- did not apply yet
No- waiting for decision
No - was denied
 How were the instructions on the website and application? (Select all that apply Perfect
Hard to understand
Too long
Not enough detail
Did not read them
A video explanation would be better
 How was the application process? (Select all that apply) Perfect
Too hard to gather documents and signatures
Had trouble typing into form
Application is too long
Do not have access to fax
Took too long to get decision
Too nitpicky on documentation
 How was the claim processing? (Select all that apply) Perfect
Too hard to get the receipt
Took too long to get paid
Too nitpicky on documentation
Would prefer electronic payment
Too much paperwork sent with the check
Paperwork sent with the check too hard to understand
 If you spoke with us (or tried to) on the phone: (Select all that apply) Perfect
Left message and was not called back
Left message and was called back next day or worse
Left message and was called back same day
Phone was answered quickly
My questions were answered clearly
My questions were not answered clearly
Did not try to call
 The qualifications for our program are: (Select all that apply) Perfect
Too generous on income
Too strict on income limits
Tumor types too restricted
Treatment types too restricted
Insurance requirement stopped me from applying
Annual $5,000 limit is too low
 Overall usefullness of our program: Extremely
Not at all
 Comments and suggestions to improve the program:
If you received a letter from us recently, please tell us the postmark date from the envelope and the date you received the letter.
If you received a "Brain Tumor Guide" from us, let us know if it was useful to you and if you think we should continue sending it out with the first claim payment.
 Ethnicity (Optional): White
Hispanic or Latino
Black or African American
Asian / Pacific Islander
Other (specify in comments above)
 Education (Optional): No schooling completed
Nursery school to 8th grade
Some high school, no diploma
High school graduate, diploma or the equivalent
Some college credit, no degree
Trade/technical/vocational training
Associate degree
Bachelor's degree
Master's degree
Professional / Doctorate degree
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