Your Voice, Your Journey: A Re-Femme Insights Questionnaire

Re-Femme: Your Voice Matters

Thank you for taking a few minutes to share your experience — your input helps Re-Femme make the cancer journey easier for women everywhere.
Your participation in this questionnaire is completely voluntary. The information you share will only be used to improve Re-Femme’s supportive services and is not considered medical advice or medical care. At times, responses may be combined with others and shared in an anonymous, aggregate form (for example, when working with hospitals or partners). Your name and personal details will never be shared.
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Oncologist Name
Hospital Name
1. Daily Life & Experience with Treatment
What stage of your journey are you in?
Which category best describes your journey?

Other
What’s been the hardest part of going through treatment?
2. Product Inquiry
What products and/or wellness services have been essential to you during your treatment?
What services have you been most interested in during your treatment? Click all that apply.

Other
3. Unmet Needs & Gaps
What services if any, at your cancer center were hard to access because of waitlists, distance, cost?
Did you experience frustrations in trying to find products you need/needed during treatment?
Can you tell me about the last time you tried to find a product or service to help support you during your cancer journey?
What part of that experience felt the most challenging/frustrating and why?
How did you end up handling the challenge and what would have made it easier?
If support were available to help with the concerns you’re facing, how open would you be to paying for a service like this? (1 = not at all open, 10 = very open)
4. Emotional & Identity Impact
What concerns came up for you as it relates to beauty/self-image after your diagnosis?
What are some moments you’ve felt least like yourself during this process?
What beauty or self-care rituals make you feel most like yourself?
5. Support Systems
If someone gave you a gift or resource during treatment, what would feel most meaningful right now?

Other
How do you prefer to connect with other women going through a similar journey?
Would you be willing to be a mentor to another woman who is newly diagnosed with your type of cancer?
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Re-Femme: Your Voice Matters

1. Daily Life & Experience with Treatment

2. Product Inquiry

3. Unmet Needs & Gaps

4. Emotional & Identity Impact

5. Support Systems