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Breast Pain Pathway Questionnaire
Did your GP advise you that breast pain on its own is not usually a symptom of breast cancer?
Yes
No
How many times have you seen your GP for this episode of breast pain prior to being referred to this clinic?
1
2
3
4
5 or more
Have you had any previous episodes of breast pain that required you to see your GP?
Yes
No
Did you find the breast pain advice that you received at this clinic to be helpful?
Yes
No
Do you feel reassured by the breast pain advice that you recieved?
Yes
No
Did you find the information regarding your personal risk of developing breast cancer helpful?
Yes
No
How easy was it to find the Breast information in your family?
Very easy
Easy
Not easy
Difficult
Very difficult
How would you rate the Family History questionnaire to complete?
Extremely easy
Easy
Not easy
Difficult
Exceedingly difficult
I did not recieve one
What would be your preferred location for the breast pain clinic?
My nearest hospital
My nearest GP practice
Nene Park Outpatient Department
I do not mind travelling to be seen by a specialist
I am not too sure
What would be your preferred day of the week to attend the breast pain clinic?
Any working day in the week
Weekend (Saturday)
I do not mind
How likely are you to recommend this service to friends and family if they have troublesome breast pain?
Extremely likely
Likely
Neither likely nor unlikely
Unlikely
Extremely unlikely
Do not know
Which hospital do you usually choose to be referred to, or which is your local hospital?
Kettering General Hospital
Northampton General Hospital
Other
So that we can assess possible demand by location within the county, what is your home postcode?
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Last name *
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