Have you had breast cancer? Yes    No

What year was your breast cancer diagnosed?

What was your age when the breast cancer was diagnosed? 44 or younger    45-59    60+

What is your ethnic background: Hispanic  Caucasian  African  Asian  Other
If other, please specify

What is the best 'gift' you received when you had breast cancer and what made it the best gift?

Select all the words that describe how it made you feel Loved  Supported  Hopeful  Optimistic
Encouraged  Happy  Strong  Joyful  Empowered  Other
If other, please specify

Who gave you the gift? Mother  Sister  Husband  Son/Daughter  Male friend  Female friend
Other  If other, please specify

Do you feel like this gift was chosen especially for you? Yes    No    Not sure

Please describe any other item, action, event, or experience that particularly gave you hope and encouragement.

Would you be willing to share your story with others? Yes    No