. Please provide your preferred daytime telephone number:
. With what racial/ethnic group do you most identify?
. What was your relationship status at the time of your diagnosis?
. Your age at initial diagnosis:
. How do you identify your sexual orientation?
. My prior peer mentoring training/experience includes:
. What type of breast cancer was part of your diagnosis?
. What stage of breast cancer was part of your diagnosis?
. Please provide details relating to your type and/or stage of diagnosis:
. Estrogen Receptor (ER)
. Progesterone Receptor (PR)
. My treatment included:
. Do you have a family history of breast cancer?
. Have you undergone genetic testing?
. Did you consider a preventative/prophylactic mastectomy?
. Did you have a prophylactic/preventive mastectomy?