Breast Cancer in Young Women screener

Attachment 4-scr: Intro/screening for Web-based Survey Instrument – English

Page 2: Landing Page (Sample 1 & 2)
Page 3: Language Selection (Sample 1 & 2)
Page 4: Survey Code (Sample 1 & 2)
Page 5: Information Page (Sample 2)
Pages 6-7: Screening Questions (Sample 2)
Page 8: Ineligibility Page (Sample 2)

1

2

3

If participant enters a code here, she will automatically be placed in Sample 1, and is already eligible to take the survey.
If left blank, the participant will be included with Sample 2 and her eligibility will be confirmed through the screener.

4

If the survey code is left blank, the participant will be directed to this information page for Sample 2:

5

Sample 2 then proceeds with 4 eligibility questions.

6

7

If a participant in Sample 2 responds “no” to any of S1-S3, or “yes” to S4, she will be ineligible to continue taking the
survey.

8