Pink Ribbon Vets Program Survey

Thank you for participating in this survey. Your responses will help us better understand the unique experiences and needs of veterans with breast cancer. Your insights will help us improve the support and resources available to you and others. All information will remain confidential.

Pink Ribbon Veterans Program Survey

Section 1: About You

What is your age?

What is your current location?

City

State

Country

What is your current employment status?

Do you have children?

Yes

Section 2: Your Military Service

Which branch of the military did you serve in?

How many years did you serve?

What was your military status?

Did you serve in a combat zone?

Yes

Were you stationed in any areas covered by the PACT Act (e.g., Iraq, Afghanistan, certain bases with toxic exposure)?

Yes

Unsure

What years were you deployed or stationed in areas with potential toxic exposure?

Have you been diagnosed with any conditions related to military exposures (e.g., burn pits, radiation, Agent Orange)?

Yes

Unsure

Section 3: Breast Cancer Journey

What stage of breast cancer were you diagnosed with?

When were you first diagnosed? (Month/Year)

What type of treatments have you received? (Check all that apply)

Surgery

Chemotherapy

Radiation therapy

Hormone therapy

Targeted therapy

Immunotherapy

Clinical trials

Other (please specify)

Please specify other treatments you have received.

Are you currently undergoing treatment?

Yes

Where do you primarily receive your breast cancer care?

Through the VA healthcare system

Outside the VA (private or civilian healthcare)

A combination of both VA and outside care

If you receive care through the VA, how satisfied are you with your care?

What challenges have you faced navigating the VA system for your breast cancer care?

Section 4: Challenges and Needs

What has been your biggest challenge during your breast cancer journey?

Have you experienced any of the following? (Check all that apply)

Physical pain or discomfort

Emotional challenges (e.g., anxiety, depression)

Financial strain

Difficulty accessing VA care

Difficulty accessing private care

Lack of support from family or friends

Body image concerns

Other (please specify)

Please specify your experiences.

What types of support have been most helpful to you? (Check all that apply)

VA resources and programs

Family and friends

Veteran support groups

Professional counseling

Peer-to-peer mentoring

Financial assistance

Wellness activities (e.g., yoga, meditation)

Online resources or forums

Other (please specify)

Please specify the other types of support.

What type of resources or support do you feel is missing or inadequate?

Section 5: Health and Wellness

Do you use any complementary therapies? (Check all that apply)

Acupuncture

Massage therapy

Herbal supplements

Mistletoe therapy

Fasting

Meditation or mindfulness

Other (please specify)

Please specify the other complementary therapies.

How important is self-care to you during your cancer journey?

Extremely important

Very important

Somewhat important

Not very important

Not important at all

What activities bring you the most peace or joy during this time?

Section 6: Community and Connection

Some description about this section

Would you use our product / service in the future?

Yes, in-person groups

Yes, online groups

If yes, what do you value most about these groups?

What do you look for in a veteran support community? (Check all that apply)

Practical advice and tips

Emotional support

Shared experiences

Access to VA resources and information

Social interaction

Other (please specify)

Please specify the other veteran support community you are looking for.

Would you be interested in sharing your story to inspire others?

Yes

Maybe

Section 7: Feedback and Suggestions

What advice would you give to another veteran newly diagnosed with breast cancer?

What is one thing you wish more people understood about being a veteran with breast cancer?

Are there any other thoughts, concerns, or suggestions you’d like to share?

Join Us Today
and Step Into a Community that Understands and Supports You!

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Gain early access to resources, support, and a community of veterans thriving together through breast cancer. Let’s navigate this journey side by side—because you don’t have to do it alone.

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Pink Ribbon Vets Program Survey

Section 1: About You

Section 2: Your Military Service

Section 3: Breast Cancer Journey

Section 4: Challenges and Needs

Section 5: Health and Wellness

Section 6: Community and Connection

Section 7: Feedback and Suggestions

Join Us Todayand Step Into a Community that Understands and Supports You!

Join Us Today
and Step Into a Community that Understands and Supports You!