Breast Screening Awareness Session Equal Opportunity Form

By filling out this form you help us ensure we are reaching all sections of the community. You will be prompted to fill out a brief questionnaire about your knowledge of Breast Screening at the end of this form and then you will receive the video link.

The information you provide in this survey is anonymous. It may be shared with our funder, the PHA.

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* 1. Please enter your postcode

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* 2. Please indicate your marital status.

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* 3. Please indicate your employment status

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* 4. Please indicate your religious or community background

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* 5. Please indicate your caring status

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* 6. Disability Status

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* 7. Please indicate your ethnic origin

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* 8. Please indicate your age range

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* 9. Please indicate your sexual orientation

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* 10. Please indicate your gender identity

0 of 10 answered
 

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