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* 1. Are you a:

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* 2. What stage is/was your diagnosis?

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* 3. What year were you diagnosed? 

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* 4. If you are a breast cancer patient/survivor, are you in active treatment at this time?

Please choose the option that best describes your current treatment status. 

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* 5. Have you experienced any of the following challenges accessing care for your breast cancer care/treatment? 

Select all that apply.      

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* 6. If your breast cancer treatment/care has been delayed, please describe by how long your care has been delayed below:

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* 7. As a caregiver of someone with breast cancer, have you experienced challenges accessing breast cancer services/resources for the person you are caring for?

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* 8. If you are presently in treatment, has your medical provider or healthcare system contacted you directly to provide medical advice on how to protect yourself against COVID-19 or access care should you have symptoms?    

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* 9. Was the information they provided helpful or satisfactory?

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* 10. Have you experienced symptoms, and have you reached out for COVID-19 testing and been denied access?

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* 11. Do you have insurance or payment concerns related to your care and treatment should you be diagnosed with COVID 19?

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* 12. Are there other challenges as a result of the pandemic you have experienced as a breast cancer patient or caregiver you’d like to share with NBCC?

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* 13. Have you previously completed and submitted this survey over the last 6 weeks?

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* 14. What state are you located in?

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* 15. If you are willing, please share your name and contact information.

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