5225 Library Rd. #223 Bethel Park, PA 15102

(412) 651-7085
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Halo Fund Survey

 

Since 2008 The Pink Pamper, Pittsburgh’s preeminent cancer-related non-profit, has been
raising money in support of our mission, which is, to improve the lives and well-being of women impacted by
the devastating and life-altering effects of a cancer diagnosis.

A portion of the proceeds raised each year are distributed in the form of a $350 voucher to women who reside in the greater Pittsburgh area to help offset some of the costs of purchasing a wig.

Thank you for taking the time to complete this survey. This will enable The Pink Pamper to raise more money to help more women with their hair replacement.
Your information will be held private and confidential unless otherwise agreed upon.

"*" indicates required fields

Name*
How would you describe the area you have spent the majority of your life?*
Please select the race that you identify with most closely:*
What is the highest level of education you completed?*
Where are you receiving treatment?*

If you did not have this financial assistance would you have still purchased a wig? **
Does hair replacement while going through chemotherapy make a difference in your daily activities such as work, church, school, family outings?*
Did hair replacement make a difference on your journey to wellness?*
This field is for validation purposes and should be left unchanged.

Thank you for filling out our survey. Your responses help us apply for future funding, to help more women, receive vouchers for their hair prosthesis.                                       

Printable Survey