YOUNG Breast Cancer in Colorado
Please take a few minutes to answer the following questionnaire. ALL QUESTIONS ARE OPTIONAL EXCEPT NAME AND AGE AT DIAGNOSIS. It is not mandatory to answer all the questions, so feel free to skip questions you do not want to answer or do not know the answer for. Responses are confidential.
There is demographic info on this questionnaire that we use to identify and map areas that are showing high rates of young breast cancer,. We will mark the location you submit to us on maps that we publish, but your name and responses will be anonymous.
If you are submitting on behalf of someone else (alive or deceased) please list their name and info as your responses.