Wellend Health

Breast Pain Data

Wellend Health Breast Density Reduction Clinical Trial Data Survey

  • Please be advised that we are now going to incorporate Breast Pain information as part of the trial's data. Would you mind completing this survey to indicate your own interpretation of the severity of your current Breast Pain (if any)

  • Please note that the fields with "*" are mandatory fields, hence your form will not be considered complete and ready to submit unless these fields have been answered.

  • QU: What would you rate your BREAST PAIN over the last couple of months?

  • Please indicate with 1 being 'very mild' and 10 being 'very severe

  • Thank you very much for taking the time to fill out this questionnaire. This information will be given to Dr Birrell to help with the preparation of Clinical Trials.

    Once form has been completed, please click SUBMIT.