Skip to content
Ovarian Cancer Screening Study Survey
Please complete this short survey to see if you qualify to participate in this study.
1.
Please leave your name, phone number, and email for us to contact you should you qualify for this trial.
Name:
Phone #:
Email:
2.
Are you at least 18 years old?
Yes
No
3.
Do you have an ovarian cyst or adnexal mass that requires surgery?
Yes
No
4.
Have you ever been diagnosed with ovarian cancer?
Yes
No
5.
Have you been treated with chemotherapy, radiotherapy, or immunotherapy in the last year?
Yes
No
6.
Are you currently pregnant, or been pregnant in the last three months?
Yes
No
7.
Do you have weakened or compromised immune system?
Yes
No