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(OLD)PAC updated exit survey
Pregnancy Aid Clinic Exit Survey
1.
Please enter the name of the PAC staff member(s) you met with today. (It's ok if you don't remember.)
Who did you meet with today:
2.
At what location did you receive services?
Forest Park clinic
Roswell clinic
Atlanta clinic
3.
How did you hear about PAC?
Google/online search
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Friend or family member
Doctor's office
Other
If you selected "other" (please specify)
4.
Did you feel comfortable talking to PAC staff about personal issues?
Very comfortable
Somewhat comfortable
Somewhat uncomfortable
Very uncomfortable
Comments?
5.
Please let us know if you agree or disagree. If it does not apply to you, check N/A
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
The PAC website was easy to navigate
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
The PAC website had relevant content
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
Online appointment scheduling was easy
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
Phone appointment scheduling was easy
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
Staff was warm and welcoming
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
Staff was helpful and knowledgeable
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
I felt heard and listened to
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
I received the information I was looking for
Strongly agree
Agree
Somewhat agree
Somewhat disagree
Disagree
N/A
Comments?
6.
What kinds of services would you like to see us add to our clinic?
7.
How can we improve our clinic?
8.
Did you receive information about our free classes?
Yes
No
Please email me some information about our education program.
ADD EMAIL ADDRESS HERE.
9.
Do you feel like your appointment was helpful today?
10.
Would you recommend PAC to a friend experiencing a potential pregnancy?
Strongly recommend it
Somewhat recommend it
Somewhat discourage it
Strongly discourage it
Comments?