BCA Peer Mentoring Questionnaire Question Title * 1. Would you be interested in volunteering to provide peer mentorship to a breast cancer patient, patient’s spouse or caregiver? Yes No Question Title * 2. If yes, your preferred method of contact (circle all that apply) Email Phone Text Skype or Facetime Video In-person support group Other (please specify) Question Title * 3. If you are a current patient, spouse, or caregiver, would you be interested in receiving peer mentorship from a volunteer? Yes No Question Title * 4. If yes, your preferred method of contact (circle all that apply) Email Phone Text Skype/Facetime video In-person support group Other (please specify) Question Title * 5. Please answer any of the following areas of support that interest you, whether it be as a volunteer or as someone receiving help Surgical: mastectomy, lumpectomy, reconstruction, going "flat," etc. Treatment: chemotherapy, radiation, lymphedema, hormone-blocking, holistic, etc. Fertility: hysterectomy, oophorectomy, chemo-related fertility issues, etc. Spousal/caregiver support Male breast cancer BRCA 1/2 positive Living with Stage 4 breast cancer Recurrent disease Diagnosis under age 40 Talking to kids about diagnosis Other (please specify) Question Title * 6. If you are interested in volunteering, please provide contact information and anything you are willing to share about your experience so we can gauge interest. Name Preferred Contact Information Done
