Form 6 Email Intake

Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI's Contact Center, Cancer Information Service (CIS) Clients

Appendix 2 Email Intake Form

CIS Email Intake Form (Appendix 2_REV)

OMB: 0925-0208

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APPENDIX 2



DATA COLLECTION INSTRUMENTS

Email Intake Form

(customer service and demographics questions)









































Email Intake Form- (upper half of page) http://www.cancer.gov/global/contact/email-us



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Email Intake Form- (lower half of page)



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