Let's start with some information about you:

What is your gender?

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* 1. What is your gender?

What is your age?

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* 2. What is your age?

Please answer the following questions:
Have you ever had sex?

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* 3. Please answer the following questions:
Have you ever had sex?

If yes, check all that apply:

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* 4. If yes, check all that apply:

If you have had sex, how often do you use condoms/rubbers?

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* 5. If you have had sex, how often do you use condoms/rubbers?

Are you aware that the health department offers birth control without parental consent for services?

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* 6. Are you aware that the health department offers birth control without parental consent for services?

Are you aware of the birth control options offered at the health department?

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* 7. Are you aware of the birth control options offered at the health department?

Are you aware that in addition to providing birth control services we also provide testing for sexually transmitted diseases?

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* 8. Are you aware that in addition to providing birth control services we also provide testing for sexually transmitted diseases?

Are you aware that birth control and testing for sexually transmitted diseases are available free of charge to teens?

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* 9. Are you aware that birth control and testing for sexually transmitted diseases are available free of charge to teens?

Do you have any suggestions on how we can improve our birth control services for teens?

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* 10. Do you have any suggestions on how we can improve our birth control services for teens?

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