Questionnaire

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Please make sure you have your pathology report handy, as you will need this information to answer some of the questions.

DISCLAIMER: The tool and the information provided are not intended to replace the medical advice of your treating physician. Do not make any decisions about your treatment without consulting your physician. Do not start or stop any medications on your own. Always check with your physician before changing any of your medications. Always consult your physician before trying herbal or “natural” or “alternative” remedies. Regularly consult a physician in matters pertaining to your health and particularly with respect to any symptoms that may require diagnosis or medical attention.

Introduction

The information used to generate the report will be reviewed and updated as appropriate based on the most current available evidence. As your medical team may have access to new treatment before this site is next updated, their medical advice may differ from what is contained in this report. Always rely on the advice of your medical team.

Privacy Statement:

All data is being collected and stored by BCC, a registered Canadian non-profit organization dedicated to breast cancer research and education. To ensure patient and caregiver privacy and confidentiality, individual responses will be anonymized and will not be identifiable. It is important to note that your information will be stored in a safe database without reference to name or any other identifying information. The data will be used to help BCC better understand the growing trends in the management of breast cancer.

Do you agree with the following statement: “I agree that this information is being provided voluntarily and by providing this information I consent to its use by BCC for internal research and statistical purposes.”