Think Pink Survey 2019
Please give us a few minutes of your time to provide valuable feedback that will help us make decisions about future breast cancer awareness efforts. To thank you for your time, we'll enter your name into a drawing for a prize donated by local businesses. Please respond by November 15th to be entered into the drawing!
Is this your first "Think Pink" bag? *
Required
If this is NOT your first bag, how many years have you received a bag?
Your answer
How old are you? *
Your answer
Gender? *
What would you like to see in the 40,000 "Think Pink" bags to be distributed next year?
Your answer
How often do you perform a breast self-exam? *
IF NOT MONTHLY, why not?
As a result of information received in the "Think Pink" bag, did you detect breast cancer? *
If you did detect breast cancer, what was the date of your diagnosis?
MM
/
DD
/
YYYY
If you are 40 years or older, did you receive a mammogram last year? *
IF NO, why? (check all that apply)
How did you receive your "Think Pink" bag? *
In which county do you reside? *
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