1.Were you offered a chlamydia test today?

yes

no

Other (please specify)

2.If so, were you given clear information about how to complete the form, use the test and receive the results?

yes

no

Other (please specify)

3.Did you know about the C Card (free condoms) service before today?

yes

no

Other (please specify)

4.Were you given information on where to pick up free condoms in Buckinghamshire?

yes

no

Other (please specify)

5.How would you rate your overall experience today?

Poor

Could Improve

Ok

Good

Excellent

Suggestions to improve

6.Would you recommend this service to a friend?

Yes

No

Other (please specify)

7.What is your gender?

Female

Male

Other (please specify)

8.What is your ethnicity?

White

Black or Black British

Asian or Asian British

Mixed

Other (please specify)

9.What is your age?

10.What district do you live in?

High Wycombe

Aylesbury Vale

South Bucks

North Bucks