Think Pink Survey 2020
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 time receiving breast health information on Think Pink Day? *
If this is NOT your first time, how many years have you received breast health information?
How old are you? *
Gender? *
What kind of information or handouts would you like to see Think Pink provide to the community?
How often do you perform a breast self-exam? *
IF NOT MONTHLY, why not?
Clear selection
As a result of information received from Think Pink, did you detect breast cancer? *
If you did detect breast cancer, what was the date of your diagnosis?
If you are 40 years or older, did you receive a mammogram last year? *
IF NO, why? (check all that apply)
In the past, if you had received a Think Pink Bag, how did you receive it? *
In which county do you reside? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy