Survey - Victor Chang Cardiac Research Institute

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About
Heart Research
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Contact Us

About
Heart Research
Support Us
Heart Disease
What's On
- Latest News
- Blog
- Events
- Tours
- Health Check Booth
Careers
Contact Us

Supporter Survey

Supporter Survey

First Name

Last Name

Email

What is your age?

18-24

25 - 34

35 - 44

45 - 54

55 - 64

65 years or older

Gender

Male

Female

Which of the following research areas are of interest to you? Please select as many as you like.

Childhood heart disease

Heart attacks

Heart failure

Hypertension

Cardiomyopathy

Cardiac arrests

Stroke

Arrhythmia

Diabetes

Spontaneous coronary artery dissection (SCAD)

How has heart disease touched your life? Please tick all the boxes that apply to you.

I have a heart condition

My partner has a heart condition

My child has a heart condition

I have lost a loved one to heart disease

I have other family members living with a heart disease

I have a friend with heart disease

I have no personal connection to heart disease

Cont.

Cont.

Tell us about your hobbies and interests. Please select those that appeal to you.

Cooking

Gardening

Travelling

Health & nutrition

Reading

Exercise

Being with family & friends

Outdoor activities

Arts & crafts

If the Victor Chang Cardiac Research Institute was to launch a national community fundraising initiative which of the below would appeal to you most? Please select two.

An exercise initiative

A clean eating/healthy nutrition program

A weight loss challenge

A quit smoking support program

A meditation practice initiative

Which of the following would you like to hear more about? Please select those that appeal to you.

The late Dr Victor Chang

Real-life patient stories

Scientific breakthroughs

Heart disease & stroke

How to reduce your risk of cardiovascular disease

Would you consider donating to the Victor Chang Cardiac Research Institute in the future?

Additional Comments

Victor Chang Cardiac Research Institute

Lowy Packer Building
405 Liverpool St
Darlinghurst, NSW 2010 Australia

P: (+61)(02) 9295 8600
F: (+61)(02) 9295 8601
E: info@victorchang.edu.au

The Victor Chang Cardiac Research Institute is registered as a charity with the Australian Charities and Not-for-Profits Commission. Eligible tax deductible donations have Deductible Gift Recipient (DGR) status with the Australian Tax Office. ABN 61 068 363 235

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