Fear of Recurrence Form
Please complete this survey to help us understand your experience with fear of recurrence and how it may affect your daily life. Your responses are confidential and will be used to improve support resources.
How often do you experience fear of recurrence?
*
Never
1
2
3
4
Very Often
5
1 is Never, 5 is Very Often
How would you rate the overall impact of fear of recurrence on your quality of life?
*
1
2
3
4
5
In which areas of daily life does fear of recurrence affect you the most? (Select all that apply)
*
Work or studies
Relationships
Sleep
Physical activity
Mood/emotions
Other
When do you notice your fear of recurrence is strongest?
During medical appointments
When feeling unwell
At night or before sleep
Around anniversaries or reminders
Other
How strongly do you agree with the following statements?
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I avoid certain activities because of fear of recurrence.
1
2
3
4
5
I find it hard to talk about my fears with others.
6
7
8
9
10
I use coping strategies to manage my fears.
11
12
13
14
15
Fear of recurrence affects my plans for the future.
16
17
18
19
20
What helps you manage your fear of recurrence? (Select all that apply)
Talking to friends or family
Professional support (e.g., counseling)
Exercise or physical activity
Mindfulness or relaxation techniques
Other
How long has it been since your initial event or diagnosis?
Please Select
Less than 6 months
6–12 months
1–2 years
More than 2 years
Prefer not to say
Would you like to share anything else about your experience with fear of recurrence?
Submit
Should be Empty: