Feedback form

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Your Personal Details
Male Female
Are you... Living with cancer
A relative or friend of someone with cancer
Caring for someone with cancer
A health professional
Other (please describe)

Treatment

Are you currently having treatment for breast cancer?
Yes
No

Breast Cancer Haven at Home

Overall, how helpful do you think Breast Cancer Haven at Home is to people affected by breast cancer? Please tick the relevant box

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DVD

How helpful did you find the following on the DVD? Please tick the relevant box

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CD

How helpful did you find the following on the audio CD? Please tick the relevant box

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General

Would you recommend this to other people affected by breast cancer
Yes
No

Using your comments

Are you happy for us to use your comments in other resources produced by Breast Cancer Haven, for example on our website?
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No

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