Thank you for taking the time to complete this survey. Your feedback is important to us! Your responses are anonymous and do not impact the assistance you receive from Breast Cancer Solutions (BCS). 

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* 1. Did you use your financial assistance within one month of receiving it?

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* 2. Which referrals from BCS did you find most helpful? Check all that apply.

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* 3. Did you miss any treatment appointments while receiving financial assistance from BCS?

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* 4. Please rate the following services provided to you by BCS:

  Excellent Good Fair Poor N/A
Customer service (courtesy, friendliness, support)
Referrals to additional resources
Ease of downloading the application from BCS website
Response time from BCS after you submitted your application
Volunteer support while receiving BCS assistance
Your ability to continue treatment while receiving BCS assistance

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* 5. What county do you live in?

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* 6. What is your ethnic background? (used for grant reporting only)

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* 7. Additional comments/feedback

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* 8. If you would like a staff member to contact you about your survey responses, please type your name and phone number in the box below.

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