Help Us Understand HER2-Negative, ER/PR+ Breast Cancer
If you or a loved one has been diagnosed with HER2-negative and ER/PR positive breast cancer (Stage III) and are currently on hormone therapy, you may qualify to participate in a market research study being conducted to better understand the patient experience.

You will be asked to participate in a 60 minutes telephone interview. If you qualify and participate, you will receive $100 for your time and participation. Only individuals over the age of 18 who live in the US are eligible at this time.

To see if you qualify or to get more information, please fill out the form below or reach out at info@pinpointpatientrecruiting.com.

Your information will be kept confidential and will not be used for any other purposes.

Sign in to Google to save your progress. Learn more
First & Last Name *
Email Address *
Phone number *
Which option best describes you? *
When were you (or your loved one) diagnosed with breast cancer? *
When first diagnosed, what stage did [your/the] doctor diagnose the breast cancer as? *
What is the breast cancer currently staged at? *
Are you (or your loved one) currently on hormone therapy?
Clear selection
How did you hear about the study?
Clear selection
Thank you!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pinpoint Patient Recruiting. Report Abuse
Google Forms