State / Province*
State / Province
Where did you receive your BAG IT bag?*
When did you receive your BAG IT bag? (Enter date as mm/dd/yyyy)*
Are you a patient or caregiver?*
Do you actively use your bag?*
I received it, but did not really use
My caregiver uses it
Are you willing to be in a focus group?
For a focus group, I would prefer (select all that apply)
Which part of The Valley/Tucson is best for you to meet?
Can we contact you via text?*
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