How to Enroll
The Breast Cancer Registry of Greater Cincinnati (BCRGC) is a local program designed to obtain information from and about women and men diagnosed with breast cancer.
Read more about the Breast Cancer Registry of Greater Cincinnati >
- Print two copies of the Consent & Enrollment Form. Retain one copy for your records.
Download Female Consent & Enrollment Form > Download Male Consent & Enrollment Form >
- Read the consent form carefully. If you have questions, please contact us at 513.558.0559 or write to firstname.lastname@example.org
- If you have read the consent form and have no questions, sign and date the consent form.
- Read through the questionnaire and then complete the form. If you have questions, write to email@example.com
- Address an envelope to:
Dr. Susan Pinney
Breast Cancer Registry of Greater Cincinnati
Department of Environmental Health
University of Cincinnati
PO Box 670056
Cincinnati, Ohio 45267-0056
- Write your return address in the upper left corner of the envelop and affix a First Class stamp to the envelope.
- Insert the signed consent form and completed questionnaire in the addressed envelope.
- Mail the stamped envelope with the signed and dated consent form and the completed questionnaire.
- File the blank copies of the consent form and questionnaire for your personal reference.
Thank You for Enrolling and Helping to Find the Causes of Breast Cancer!