Love Your Birth Control - Pre-Survey
This is an anonymous survey and your responses will not be linked to you as an individual. Your answers also will not be discussed in the training.
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To clarify, please put the date of the training you are registered for: *
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Favorite Number?
In the past year, about how many of your patients/clients have presented with a concern about lack of contraception? *
In the past year, about how many of your patients/clients have presented with a concern about sexually-transmitted diseases? *
In the past year, about how many of your patients/clients have presented with a concern about unintended pregnancy? *
To what extent do you agree or disagree with the following? *
Strongly Agree
Agree
Disagree
Strongly Disagree
A person's race, socioeconomic status, or cultural background does not impact thir access to contraception.
I am comfortable providing clients with information about emergency contraception.
I have the skills and information I need to effectively counsel a client on all contraceptive methods.
IUDs can be inserted in adolescents.
This site offers or will offer all contraceptive methods, including LARCS, on site.
All clients should be able to choose their method of contraception.
Clients should pick what contraceptive methods they want to be counseled on.
In the past year, about how many patients/clients have you referred for emergency contraception? *
In the past year, about how many patients/clients have you referred for prenatal care? *
In the past year, about how many patients/clients have you referred for a contraceptive method not stocked on site? *
What do you hope you gain or learn from today's training? *
If you are willing, please take a moment to fill out the demographic questions below. These questions are optional and will be used for data and reporting purposes only for funding and evaluation. If you do not wish to give this information, please scroll down and click 'submit'.
What is your age?
What is your race? Please indicate all that apply:
Are you Hispanic or Latinx/Latine?
Clear selection
What is your gender identity?
What are your preferred gender pronouns? (example - she/her, he/his, they/theirs)
In what counties do you work?
What is your household income?
Clear selection
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