Survey

Dear Participant. Thank you for participating in this survey.

We are initiating a NGO and aim to use the information from this survey to ensure we use our time and funds correctly.

All information in this survey will be handled strictly confidential and no personal information will be given to a third party.

Current Age *

At what age were you diagnosed with breast cancer ? *

How did you discover the lump in your breast ?

At your first consultation with a medical doctor, were you informed that this could be breast cancer? *

Did your doctor refer you for investigations after the first visit ? *

Did you go for a mammogram/sonar ?

If you had a mammogram/sonar, did they do or suggest a biopsy ? *

What was your experience at the mammogram/sonar? How did they treat you? Compasionate or just another patient. *

* Other

Did you undergo chemotherapy and/or radiation ? *

What do you think is the cause of your breast cancer ? *

* Other – Cause of Breast Cancer

* Other

Did your GP, surgeon or oncologist suggest genetic testing ?

Do you know of anyone with genetic or triple negative breast cancer? *

If Yes for genetic or triple negative cancer, who do you know? *

* Other – Genetic

If you underwent surgery, did your doctor suggest wearing post surgery bra's ?

Did your medical aid cover the cost of the bra's?

Did you wear a wig during and after treatment ?

Did your medical aid cover the cost of the wig ?

Thank you for your participation in this survey. If you would like us to reach out to you, please provide us with your name, contact number. *

First

Last

Email *

We are a Non Profit Company registered with registration number 2023/097593/08, engaged in the education of Hereditary and Familial Cancer.

CONTACT

Pretoria, Gauteng

AngelM Breast Cancer Survey