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* 1. When were you diagnosed with breast cancer?

* 2. Were you diagnosed with ER positive breast cancer?

* 3. Were you prescribed hormonal therapy as part of your treatment for your breast cancer?

* 4. If yes, are you still taking your hormonal therapy medication?

* 5. What is your full name?

* 6. What is your email address?

* 7. What is your mailing address?

* 8. At what phone number would you like to be contacted?

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