2017 CHOICES Patient Satisfaction Survey Thank you for choosing CHOICES for your reproductive and sexual health services. In order to improve our services, please take a moment to fill out this SHORT survey. Those who complete the survey will receive a CHOICES gift! As a reminder, all of your responses are anonymous. If you have any questions, please feel free to contact us at 901-274-3550 ext. 104. Question Title * 1. How likely would you be to recommend Choices. Memphis Center for Reproductive Health, to a friend for reproductive or/and sexual health services. 0. Not at all likely 1 2 3 4 5 6 7 8 9 10.Very likely 0. Not at all likely 1 2 3 4 5 6 7 8 9 10.Very likely Question Title * 2. Please tell us why you gave this answer. Question Title * 3. What do you consider your sexual orientation? Straight Bisexual Gay Lesbian Pansexual Asexual Other (please specify) Question Title * 4. What do you consider your gender? Female (Cisgender Woman) Male (Cisgender Man) Transgender Man Transgender Woman Nonbinary/ Gender Nonconforming/ Genderqueer Other (please specify) Question Title * 5. What do you consider your race/ethnicity? Asian Black Hispanic White Other: (please specify) Question Title * 6. What is your current zip code? Question Title * 7. How did you hear about CHOICES? Google Event/ Health Fair La Prensa Latina Memphis Flyer Social Media: Facebook/Twitter/ Instagram Radio (Ambiente 1030) Cards/ Flyers Friend/Family Other: Please tell us how you heard about us. Question Title * 8. What type of medical services did you receive at CHOICES? Medical Abortion (non-surgical form of abortion in which the woman takes pills containing Mifepristone) Surgical Abortions (involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus) Birth control HIV Testing STI Testing PAP smears and gynecological services Pregnancy testing Fertility Assistance PrEP Services PEP Services Hormone Replacement Therapy Other: Please tell us what services you received. Question Title * 9. Please rate your knowledge BEFORE coming to Choices about your sexual health. 0 - I had NO knowledge about my sexual health options. 1 - I had a little knowledge about my sexual health options but mostly just questions. 2 - I had a good bit of knowledge about my sexual health options but some questions. 3 - I had an extensive knowledge about my sexual health options and had no questions. 0 - I had NO knowledge about my sexual health options. 1 - I had a little knowledge about my sexual health options but mostly just questions. 2 - I had a good bit of knowledge about my sexual health options but some questions. 3 - I had an extensive knowledge about my sexual health options and had no questions. Question Title * 10. Please rate your knowledge AFTER coming to Choices about your sexual health. 0 - I had NO knowledge about my sexual health options. 1 - I had a little knowledge about my sexual health options but mostly just questions. 2 - I had a good bit of knowledge about my sexual health but some questions. 3 - I had an extensive knowledge about my sexual health options and had no questions. 0 - I had NO knowledge about my sexual health options. 1 - I had a little knowledge about my sexual health options but mostly just questions. 2 - I had a good bit of knowledge about my sexual health but some questions. 3 - I had an extensive knowledge about my sexual health options and had no questions. Question Title * 11. Have you done any of the following activities since your visit to CHOICES? Yes No Sometimes Not Applicable I have consistently used birth control since my visit to Choices. I have consistently used birth control since my visit to Choices. Yes I have consistently used birth control since my visit to Choices. No I have consistently used birth control since my visit to Choices. Sometimes I have consistently used birth control since my visit to Choices. Not Applicable I have consistently used birth control since my visit to Choices. I have shared what I learned about birth control and/or sexual health options with a friend. I have shared what I learned about birth control and/or sexual health options with a friend. Yes I have shared what I learned about birth control and/or sexual health options with a friend. No I have shared what I learned about birth control and/or sexual health options with a friend. Sometimes I have shared what I learned about birth control and/or sexual health options with a friend. Not Applicable I have shared what I learned about birth control and/or sexual health options with a friend. I have had UNprotected sex. I have had UNprotected sex. Yes I have had UNprotected sex. No I have had UNprotected sex. Sometimes I have had UNprotected sex. Not Applicable I have had UNprotected sex. I have consistently used a method of birth control. I have consistently used a method of birth control. Yes I have consistently used a method of birth control. No I have consistently used a method of birth control. Sometimes I have consistently used a method of birth control. Not Applicable I have consistently used a method of birth control. Question Title * 12. Is there anything you would suggest to improve our center? Question Title * 13. Would you be willing to talk about your visit at CHOICES in more detail? YES NO If yes, please add contact information in box (name, email, contact number) Question Title * 14. CHOICES does not discriminate against any person on the basis of race, age, gender identity or expression, sexual orientation, body size, religion, cultural heritage, or disability. Please report any instances of discrimination to Choices by calling 901-274-3550 ext. 104. Or in the box provided below. Next