SURVEY BREAST CANCER SURVIVORS AND WARRIORS Explore Our Resources Page Click Here Survey Form Please fill out the form. Thanks! Name Phone Email Size Age 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61+ Household Income Under $20,000 $20,001-$40,000 $40,001-$60,000 $60,001-$80,000 $80,001-$100,000 $100,001 or Over Are you of Hispanic, Latino or Spanish Origin Yes No How do you describe your ethnicity? Native American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Unknown Other prefer to self describe Don't wish to answer What items would you like to purchase? Active Spots Apparel, Leisure Clothing, Lingerie/Night Dress, Bra's, Camisoles, Swimwear, Or What items would you like to see more as options in the current market? Active Spots Apparel, Leisure Clothing, Lingerie/Night Dress, Bra's, Camisoles, Swimwear, Or What colours would you like to see in swimwear? What colours would you like to see in Active Spots Apparel, Leisure Clothing, Lingerie/Night Dress, Bra's, Camisoles, Or What styles and silhouttes in swimwear would you like? Tankini's Swimdress Two piece/bikini swimsuits One piece swimsuit One piece sporty/front zipper swimsuits Monokini swimsuit -(One piece with sides cut outs The Side/Brazilian/Scope/ High Waist/Thong/Full Briefs/ Bottoms What price points would you be willing to spend for a designer quality swimsuit? Would you like a custom swimsuit? Are there any fabric patterns you would like to see in Styles/ Silhouttes? IE: Animal, Floral, Abstract etc. When do you wear a swimsuit the most? Cruise/ Vacations, Water physical therapy in a pool, Home recreational pool? Do you like coverups? Have you selected a prothesis or do you use a swim form for your swimwear? Submit
