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CART-WHEEL Questionnaire Demonstration Created: December 2009 by CART-WHEEL, Updated August 2013 This document contains screenshots of all pages of the questionnaire to give you a better feeling for what we are asking and how the questionnaire works.

Content:

Start page and welcome screen after login ........................................................................................................... 2

Question 1: Personal Details .................................................................................................................................. 3

Question 2: Contact details ..................................................................................................................................... 4

Question 3: Diagnosis ............................................................................................................................................. 5

Question 4: Tumor location .................................................................................................................................... 6

Question 5: Hospitals .............................................................................................................................................. 7

Question 6: Doctors ................................................................................................................................................. 8

Question 7: Biopsy details ...................................................................................................................................... 9

Question 8: Operation details ............................................................................................................................... 10

Question 9: Treatment details ............................................................................................................................... 11

Question 10: Treatment Side effects .................................................................................................................... 12

Question 11: Radiation details .............................................................................................................................. 13

Question 12: Clinical trial details .......................................................................................................................... 14

Question 13: General Health ................................................................................................................................. 15

Question 14: Smoking/Alcohol consumption ..................................................................................................... 16

Question 15: Other tumors .................................................................................................................................... 17

Question 16: Family Cancer History .................................................................................................................... 18

Question 17: Family Gene Test ............................................................................................................................. 19

Question 18: Tumor Gene Test ............................................................................................................................. 20

Question 19: Comments ........................................................................................................................................ 21

Summary of all information ................................................................................................................................... 22

Settings: My Login Details .................................................................................................................................... 23

Start page and welcome screen after login

Question 1: Personal Details

Question 2: Contact details

Question 3: Diagnosis

Question 4: Tumor location

Question 5: Hospitals

Question 6: Doctors

Question 7: Biopsy details

Question 8: Operation details

Question 9: Treatment details

Question 10: Treatment Side effects

Question 11: Radiation details

Question 12: Clinical trial details

Question 13: General Health

Question 14: Smoking/Alcohol consumption

Question 15: Other tumors

Question 16: Family Cancer History

Question 17: Family Gene Test

Question 18: Tumor Gene Test

Question 19: Comments

Summary of all information

Settings: My Login Details