Welcome to the Teen Clinic!  We want to hear from you.  Your feedback regarding Teen Clinic Services would be greatly appreciated.  All information collected is strictly confidential and is used for future planning only.  No identifying information is collected.

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* 1. My gender:

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* 2. My age in years:

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* 3. Location of clinic (School Name):

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* 4. I became aware of the Teen Clinic through: (please choose all that apply)

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* 5. I have attended a Teen Clinic in the past year.

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