STI 101 Post-Survey

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* 1. Name:

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* 2. What age category are you in?

Under 15

15-20

21-24

25-34

35-44

45+

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* 3. What gender are you?

Male

Female

Other

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* 4. Chlamyida and Gonorrhea are curable with prescribed medicine.

True

False

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* 5. Gardasil is a vaccine that helps prevent human papilloma virus (HPV).

True

False

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* 6. Over 75% of people will exhibit a sign or symptom when they have an STI.

True

False

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* 7. HIV stands for human immunodeficiency virus.

True

False

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* 8. What are the 3 progression stages of syphillis?

First, Second, Third

Primary, Secondary, Teritary

Stage 1, Stage 2, Stage 3

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* 9. Hormonal contraceptives help protect me against STIs.

True

False

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* 10. How did you hear about Midtown Health Center?

Social Media (Facebook, Instagram, Twitter, Snapchat)

T.V. or Radio

From friends and family

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* 11. What is 1 thing you learned in the STI 101 presentation?

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* 12. If you would like to be entered into the drawing for a gift card, please leave your contact information below!

Name

Email Address

Phone Number