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* 1. At which location do you usually receive services?

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* 2. What is your age?

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* 3. Are you: 

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* 4. What city or town do you live in?

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* 5. How long have you been a patient at OCO's Centers for Reproductive Health?

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* 6. How many days after you call are you scheduled for an appointment?

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* 7. Are The Centers Staff prompt and helpful when you arrive to check-in for your appointments?

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* 8. How easy is it to receive services at The Centers?

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* 9. How convenient are The Centers hours/days?

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* 10. Please rate The Center's cleanliness.

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* 11. How helpful were The Centers Staff?

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* 12. Do you feel like you were treated respectfully?

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* 13. Were all of your questions and concerns addressed?

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* 14. How satisfied are you with the services you receive from us?

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* 15. How well did the program meet your needs?

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* 16. What services have been most helpful to you (for example: birth control, STD testing, annual exams)?

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* 17. Were there other services you needed that OCO could not help you with?

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* 18. If yes to question 17, please describe:

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* 19. In the last year, have you gone anywhere else for birth control or reproductive health care?

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* 20. If yes to question 19, where have you gone?

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* 21. Would you recommend OCO's Centers for Reproductive Health to a friend?

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* 22. Please share any additional comments or suggestions you may have for us: 

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