Chest Binder Experience Survey

1

Name* This field is required.

First Name

Last Name

2

Pronouns* This field is required.

3

Age* This field is required.

4

Email* This field is required.

example@example.com

5

Phone Number

Please enter a valid phone number.

6

Best way to reach you:

Phone Call

Text

Email

7

How would you describe your gender identity?

8

Address* This field is required.

Country

9

Are you willing to be featured in a news article by name?* This field is required.

YESNO

10

Have you ever received a chest binder from Point of Pride?

YESNO

11

Have you ever worn a chest binder? Or, do you currently wear one?

YESNO

12

What benefits do you feel that using a chest binder has had for you?

13

How long have you been using chest binders? If you no longer wear them, how long do you remember using them?

0-1 year

1-3 years

3-5 years

Over 5 years

14

If you no longer wear a chest binder, what is your reason for no longer using one?

I had top surgery

I no longer felt like wearing it

I now use a different binding method (e.g. binding tape)

Other

15

Is there anything else you would like us to know about your experiences using chest binders?