The purpose of this study was to develop a questionnaire that could be used in further studies pertaining to breast cancer.Women (n = 15; x age = 34.0 yrs.) in the Ball State University Adult Fitness Program completed a questionnaire concerning dietary history, physical activity history, age at menarche and menopause, family history of cancer, parityand regularity of menstrual cycles.The questionnaire questions were reviewed for ambiguities, inadequate instructions, incomplete or misunderstood questions and ease of tabulation. A revised questionnaire was then given to five of the original fifteen subjects along with specific follow-up questions pertaining to the revised questionnaire to ascertain the effectiveness of the revised questionnaire. The revised questionnaire, as it appears in Appendix D, was found to be apparently valid, and therefore is the form recommended for further investigative studies.