Check on the GIRLS
Thank you for performing this anonymous survey.

We wont sell or release your email;  nobody likes spam!

We will be using this to help educate women on performing a better home breast exam.  Early detection leads to improved survival.

We enjoy hearing your thoughts on the GIRLS method,  contact Dr. Holtrop at checkonthegirls.org
Sign in to Google to save your progress. Learn more
Section 1:  For women who have not used the GIRLS method (or answer as to how you used to perform your breast exams before learning this method)
How often do you perform home breast exams?
Clear selection
Do you look in the mirror for dimpling or one sided changes in the shape of your breasts?
Clear selection
Do you look for skin changes in your breasts?
Clear selection
Do you feel for growths or masses  in your breasts?
Clear selection
Do you feel for lymph nodes in your armpit?
Clear selection
When you feel your armpit is your arm up or down by your side?
Clear selection
Do you squeeze your nipple looking for brown or bloody discharge?
Clear selection
Section 2: For women who have been using the "GIRLS" method
 How helpful is this method for performing a complete 5 point monthly home breast exam?  (4 is the best)
Useless, get a real job
Best exam ever!!
Clear selection
What area of the breast exam were you missing in the past?  (check all that apply)
Submit
Clear form
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms