Background: In recent years FP has been a growing concern for young women diagnosed with breast cancer. ASCO has recommended that such women be referred to a reproductive specialist as early as possible before beginning systemic adjuvant therapy. Aim: To gather information about young breast cancer patients’ experiences with FP referral, consultation, and decision making. Methods: Anonymous questionnaires were mailed to consecutive breast cancer patients referred January 2005 through January 2010 from our center to the CReATe clinic in Toronto. Topics included information about demographics, cancer stage and treatment, previous fertility problems, referral source and timing, options presented and chosen, and satisfaction with the referral, consultation and decision making processes. Results: Of the 50 women identified 26 (52%) participated. Average age of respondents was 31 (range 24-41). 17 (65%) were married or in a long-term relationship, and 9 (35%) already had 1 child. Seven (27%) were referred before surgery, 16 (62%) after surgery but before systemic therapy, 2 (8%) after starting hormone therapy, and 1 after completing chemotherapy. Only 54% opted for FP. Of the 17 (66%) who reported plans to start/add to their family prior to diagnosis of breast cancer, 53% proceeded with FP and of the 9 who did not have plans to start/add to their family 5 (55%) pursued FP. 41% had difficulty with decision making and 50% found cost to be a significant barrier. A common theme among respondents was inadequate time for decision making. Several complained about the lack of written material before and/or after their consultation. 85% felt that access to a psychosocial counselor would have been beneficial to the decision making process. 57% were satisfied or extremely satisfied overall. Conclusions: (1) If appropriate, FP referral should be initiated by the surgeon as soon as a diagnosis of invasive cancer is made. Obtaining receptor and HER2 status on core biopsy samples may identify women who will require systemic therapy and may benefit from early FP referral. (2) Women need written materials before and after FP consultation. (3) There is a major role for a FP counselor who is able to spend additional time helping with decision making.