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Thank you for helping us make sure For the Love of My Gurls is doing what it set out to do - educate, equip and empower women like YOU to prioritize #BlackBreastHealth. Your input will help save lives!  Although your responses are confidential, this survey is not anonymous. Your continuation of this survey is your consent to participate and recontact. 

By completing this survey (which should take about 5 minutes) you will be entered into a raffle to win a $100 gift card to Aerie! We’ll be pulling a winner every month!

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* 1. What is your email address?

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* 2. What is your phone number?

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* 3. What is your zip code?

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* 4. How old are you?

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* 5. What sex was originally listed on your birth certificate?

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* 6. Have you ever had a breast cancer diagnosis?

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* 7. What is your ethnicity?

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* 8. What is your race? (Choose all that apply)

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* 9. Where did you first see or hear the For the Love of My Gurls campaign? (Choose all that apply.)

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* 10. Thinking about where you are now, please rate the following statements based on your current knowledge, awareness, and plans today after you saw the For the Love of My Gurls campaign materials. Please rate your agreement with the following statements on a scale from 1 strongly disagree to 5 strongly agree.

  Strongly Disagree Disagree Undecided Agree Strongly Agree
I’m aware that breast health looks different for Black women.
I know the importance of knowing my HERstory (family health history) for understanding my risk.
I understand why it is important to get to know my gurls (check my breasts).
I know how and when to get to know my gurls.
I know what to do if I feel something new or unusual while getting to know my gurls.
I understand the importance of Black women participating in clinical trials.
I plan to share new learnings about Black Breast Health with friends or family.
I plan to talk to my family about my HERstory (family health history).
I plan to share my HERstory (family health history) with my healthcare provider.
I plan to get to know my gurls this month.
I plan to get to know my gurls monthly.

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* 11. Think back to at least 1 month ago and please rate the following statements based on your knowledge, awareness, and plans before you saw the For the Love of My Gurls campaign materials. Please rate your agreement with the following statements on a scale from 1 strongly disagree to 5 strongly agree.

  Strongly Disagree Disagree Undecided Agree Strongly Agree
I was aware that breast health looks different for Black women.
I knew the importance of knowing my HERstory (family health history) for understanding my risk.
I understood why it was important to get to know my gurls.
I knew how and when to get to know my gurls.
I knew what to do if I felt something new or unusual while getting to know my gurls.
I understood the importance of Black women participating in clinical trials.
I planned to share new learnings about Black Breast Health with friends or family.
I planned to talk to my family about my HERstory (family health history).
I planned to share my HERstory (family health history) with my healthcare provider.
I planned to get to know my gurls this month.
I planned to get to know my gurls monthly.

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* 12. When was you last doctor's appointment?

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* 13. Do you currently have medical insurance?

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* 14. Please share anything else that you would like to know or share with us about the For the Love of My Gurls campaign.

Thank you so much for completing the LMG Survey! Remember to stay in TOUCH with your Gurls!

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