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* 1. What clinic did you visit?

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* 2. How happy are you with the service(s) you got from Family Planning?

  Very happy Mostly happy  Happy Not very happy Very unhappy
Phone call
Nurse
Doctor
Reception

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* 3. How did you make your appointment?

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* 4. How happy were you with the way your appointment was made?

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* 5. How often do you come to a clinic?

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* 6. How did you find out about the clinic/service?

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* 7. How were you treated?

  Strongly agree Agree Undecided Disagree Strongly disagree
I was listened to 
When I asked a question, I got an answer I understood

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* 8. Would you recommend us to your friends?

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* 9. Would you consider:

  Yes Maybe  No
Using Skype or another online option to talk with us
Using drop-in appointments more often 
Visiting a clinic just for young people
Visiting a clinic just for men

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* 10. Was the time it took you to get an appointment acceptable?

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* 11. What can we do to improve our services?

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* 12. Are you a New Zealand resident?

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* 13. Do you have a Community Services Card (CSC)?

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* 14. How old are you?

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* 15. What gender do you identify with?

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* 16. What ethnicity do you identify with?

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