Share my story - CoppaFeel!

Contact Details

Name*

First Last

Pronouns

e.g: she/her, he/him, they/them

Contact:

Please indicate if you would be happy for us to contact you about your story - and how you would prefer to be contacted.

I am happy for CoppaFeel! to contact me via email
I am happy for CoppaFeel! to contact me via telephone

Email*

We will use the email address provided here to contact you about your story, if you consent for us to do so. We will never use it to send you spam. Promise.

Phone

We might use the phone number provided here to contact you about your story, if you consent for us to do so. We will never use it for spam or marketing stuff.

Date of Birth:

Your experience

Please select the field that best describes your experience:*

I've been diagnosed with breast cancer
I've had a breast cancer scare
I have an increased risk of breast cancer due to hereditary factors / a family connection
Someone close to me has been diagnosed with breast cancer
Other

If other, please specify:*

How old were you when this happened?*

Did CoppaFeel! play any role in your experience?*

Yes
No

Which of our services were you impacted by?

It's really important for us to know which of our campaigns and services are helping to affect most change. If your story relates to any of the categories below, please let us know here. You may tick all that apply, or leave blank if none.

Text Reminder
Bra Label
Shower Sticker / Hanger
Social Media
Boobette talk
Uni Boob Team
on TV / in the media
Celebrity or influencer
CoppaFeel! Boob Bot

If celebrity or influencer, please indicate who:

Please tell us a little about your experience.

You don't need to provide loads of detail here, just try to sum up the key information you'd like us to know and our team will be in touch to talk through the details.

Publishing your story*

We sometimes seek consent to share stories like yours with our community, for example, by publishing them on social media or on our website. Please indicate if you would be interested in doing this and a member of our team will follow up with more information.

I would be happy for CoppaFeel! to seek consent to publish my story
I don't want CoppaFeel! to publish my story

Anonymity

If we shared your story, would you wish to remain anonymous?

I do not wish to remain anonymous
I would like to remain anonymous

Equal Opportunities

The following questions are optional. Any data you give will be linked to your submission and will be used to track the reach of our work and help us to better represent the vast and varied experiences of young people in the stories we share.

For information on CoppaFeel!'s commitment to equality and inclusion, click here.

Which of the following best describes your gender?

Male
Female
Prefer not to say

If you describe your gender with another term, please provide this here:

Do you identify as trans?

Which of the following best describes your sexual orientation?

Bi
Gay or Lesbian
Heterosexual/straight
Prefer not to say

If you describe your sexual orientation with another term, please provide this here:

Do you consider yourself to be disabled?

What is your age?

What is your ethnic group

If other ethnic group, or if you would prefer to use your own term, please specify:

What is your religion

If you would prefer to use your own term, please specify:

Thank you

How did you hear about us?

If other, please specify:

Sign up for our newsletter

Once a month we send out Boob Mail, an email round up of the latest news, ways you can support us and puns direct from CoppaFeel! If you are not already signed up we suggest you do pronto by ticking the box below. (You can always unsubscribe at any time.)

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Volunteering
Sporting Events and Challenges
Other ways to support

For more information on how we look after your information please see our privacy policy.

Consent

I agree to the privacy policy.

I want to share my story

Contact Details

Your experience

Equal Opportunities

Thank you