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Komen OC COVID-19 Community Needs Assessment

 

 

Susan G. Komen Orange County recognizes what a difficult time this is for many in our community.  We request your help in identifying key issues impacting your well-being during the COVID-19 pandemic.  We ask all breast cancer patients in all stages of diagnosis, treatment, breast cancer survivors and those living with metastatic breast cancer to participate in this needs assessment. 

This 5-minute survey will further our understanding of your experience over the past months and help link you to community resources if needed.

 

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Question - Not Required - Do you need support with any of the following? *(select all that apply)
Please make between 1 and 10 selections from the choices below.

 

 

 

*While Komen Orange County will make all good faith efforts to connect you to the above resources, receiving any of the above services is not guaranteed and is up to the capacity and qualifications of the organization providing the direct assistance.

 

This information will only be seen by the Komen Orange County Affiliate.  If you are seeking any services above, a representative from Komen Orange County will be in contact with you for the assistance you requested.  Only then, would your information be potentially shared with a Komen-partner agency, upon your verbal or written consent to link you to the services you need.

 

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(Maximum response 255 chars, approx. 5 rows of text)

 

(Maximum response 255 chars, approx. 5 rows of text)

 

(Maximum response 255 chars, approx. 5 rows of text)

   


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Thank you for your participation.  If you have any questions, please contact us at info@komenoc.org or (714) 957-9157

 

   Please leave this field empty