Clone of Busting Out of Silence Medical Survey

Busting Out of Silence Medical Survey

Anonymous Medical Campaign Questionnaire for Online Reporting
Hosted on: www.thebionicbras.com

Campaign Founder: Dr. Pamela McQueer, ND, CHS, CHNP

Founder, Bionic Sports USA | Creator of The Bionic Movement | Inventor of the Bionic Bra

This questionnaire is for athletes reporting previous or current breast sports-related injuries. The purpose is to collect anonymous information that can help improve awareness, reporting, prevention, research, and future safety standards in sports.
IF YOU ARE UNDER THE AGE OF 18, A PARENT OR LEGAL GUARDIAN MUST COMPLETE THIS FORM.
Parent/Guardian Questionnaire
Age range*
Country or region you live or play in
Level you play or did play

Youth / RecreationalMiddle SchoolHigh SchoolClub / TravelCollege / UniversitySemi-professionalProfessionalOther
Sport most connected to the injury
Reporting and Care
Did your child report breast pain, injury, bruising, swelling, or a lump after sports?*

Yes, currentlyYes, in the pastYes, both past and current problemsNot sureNo
If other symptoms, please describe them
Did you seek medical evaluation?

YesNo
Was the concern taken seriously?

YesNo
Was there any diagnosis such as fat necrosis, hematoma, scar tissue, or trauma-related breast change?*

YesNo
What barriers made reporting difficult?
Current Impact and Awareness
What do you want coaches, trainers, schools, and sports organizations to understand?
Should be Empty:

Busting Out of Silence Medical Survey