Meet H.E.R Breast Ultrasound Experience Survey
Thank you for allowing Meet H.E.R to be part of your breast health journey. Your anonymous feedback helps us improve access to portable breast ultrasound services and expand breast health education in communities across the country. -
How comfortable was your breast ultrasound experience?
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1
2
3
4
5
1-Very Uncomfortable 5-Very Comfortable
How satisfied were you with the ultrasound technologist and how clearly everything was explained?
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1
2
3
4
5
1-Very Dissatisifed 5-Very Satisfied
How anxious or nervous were you before today's ultrasound?
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1
2
3
4
5
1-Not Nervous 5-Extremely Nervous
After today's visit, how confident do you feel about taking charge of your breast health?
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1
2
3
4
5
1-Not Confident 5-Very Confident
Would you recommend Meet H.E.R's portable breast ultrasound program to a friend or family member?
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Yes
No
If no, please tell us why.
What did you value most about today's ultrasound experience? (Check all that apply)
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Comfortable experience
Convenient Location
Easy Scheduling
Friendly Staff
Education I recieved
Immediate next steps
No referral required (If Applicable)
Portable/mobile service
Privacy
Access close to home
Other
When was your last breast imaging?
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Less than 1 year ago
1-2 years ago
More than 2 years ago
I've never had breast imaging before
If never, what prevented you from getting screened?
Age
*
18-25 years old
26-35 years old
36- 45 years old
46- 55 years old
56+ years old
Race/Ethnicity
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African American
Caucasian
Hispanic
Asian
American Indian
Middle Eastern
Prefer not to answer
Other
Highest Level of Education
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High School Diploma or GED
Some College
Associate Degree
Bachelor's Degree
Graduate Degree
Prefer not to answer
Approximately how far did you travel today?
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Less than 10 miles
10-25 miles
26-50 miles
More than 50 miles
Employment Status
*
Employed Full-Time
Employed Part-Time
Self-employed
Student
Retired
Unemployed
Other
What kept you from getting breast imaging sooner?
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Cost
No insurance
Couldn't get an appointment
Transportation
Childcare
Fear or Anxiety
Didn't know where to go
Work Schedule
N/A
Other
How did you hear about Meet H.E.R?
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Social Media
Friend/Family
Employer
Church
Community Event
Physician
Community Organization
Other
Would you like to receive information about future breast ultrasound events and women's health resources?
*
Email
Text
Both
No Thanks
Submit
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