Bucks THT Professsional Consultations Question Title * 1. Were you offered a chlamydia test today? yes no Other (please specify) Question Title * 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) Question Title * 3. Did you know about the C Card (free condoms) service before today? yes no Other (please specify) Question Title * 4. Were you given information on where to pick up free condoms in Buckinghamshire? yes no Other (please specify) Question Title * 5. How would you rate your overall experience today? Poor Could Improve Ok Good Excellent Suggestions to improve Question Title * 6. Would you recommend this service to a friend? Yes No Other (please specify) Question Title * 7. What is your gender? Female Male Other (please specify) Question Title * 8. What is your ethnicity? White Black or Black British Asian or Asian British Mixed Other (please specify) Question Title * 9. What is your age? Question Title * 10. What district do you live in? High Wycombe Aylesbury Vale South Bucks North Bucks Done
