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Blush Cancer Care

Blush Cancer Care

Blush Feedback Forms

Thank you for providing valuable feedback on our programs and support.

Please fill in the form relevant to you as listed below. Thank you.

Your name (if you are happy to provide it)

First Name

Last Name

Email

Phone

(###)

###

####

Did you receive a Blush Care Pack during your breast cancer treatment?

Yes

No

Please rate the items in the pack with 1 being not valuable or used and 10 being extremely valuable and used.

Option 1

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Option 2

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Radio

Option 1

Option 2

Thank you so much for your proposal to run an event benefitting Blush Cancer Care.

Proposals are discussed at the Events Committee Meeting every month and after that one of our team will be in contact to discuss the details of your proposal.

Thank you again for your support.

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First Name

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Email Address

Thank you!

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