Let's start with some information about you:

* 1. What is your gender?

* 2. What is your age?

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

* 4. If yes, check all that apply:

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

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

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

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

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

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

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