English Español Polski Українська العربية فارسی 中文 English Thank you for taking the time to complete this confidential survey. Your feedback is important to us, and it will help us improve our care. Question Title * 1. Where did you get care? Alivio Medical Center Asian Human Services Family Health Center Aunt Martha's Health and Wellness Chicago Family Health Center Christian Community Health Center Erie Family Health Centers Esperanza Health Centers Friend Health Near North Health PCC Community Wellness Center Tapestry 360 Health PrimeCare Health Rush University Medical Group Sinai I don't know Other Question Title * 2. What health plan do you have? CountyCare Private insurance I don’t know Other Question Title * 3. When was your last contraceptive care visit? Within the last 30 days 6 months ago 1 year ago More than 1 year ago I don't know Other This section of the survey is about your visit to your clinic. Your answers are private and your healthcare providers will not see your individual answers. Question Title * 4. Think about your visit. How do you think your clinic or provider did? Please rate them on each of the following by clicking on your rating. Poor Fair Good Very good Excellent Respecting me as a person Respecting me as a person Poor Respecting me as a person Fair Respecting me as a person Good Respecting me as a person Very good Respecting me as a person Excellent Letting me say what mattered to me about my birth control method Letting me say what mattered to me about my birth control method Poor Letting me say what mattered to me about my birth control method Fair Letting me say what mattered to me about my birth control method Good Letting me say what mattered to me about my birth control method Very good Letting me say what mattered to me about my birth control method Excellent Taking my choices about birth control seriously Taking my choices about birth control seriously Poor Taking my choices about birth control seriously Fair Taking my choices about birth control seriously Good Taking my choices about birth control seriously Very good Taking my choices about birth control seriously Excellent Giving me enough information to make the best decision about my birth control method Giving me enough information to make the best decision about my birth control method Poor Giving me enough information to make the best decision about my birth control method Fair Giving me enough information to make the best decision about my birth control method Good Giving me enough information to make the best decision about my birth control method Very good Giving me enough information to make the best decision about my birth control method Excellent Done