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Reproductive Health Customer Service Survey Carroll County MD Health Department
Thank you for completing this quick, anonymous survey. Your answers will help us improve our services!
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Which Reproductive Health services did you use most recently? Please check all that apply.
STI Testing and Treatment
Reproductive Health education
Cancer screening
HIV/Hepatitis C testing
Family planning / Birth control
Preconception counseling
Pregnancy testing
Emergency contraception
Other:
At which location did you receive services?
Carroll County Health Department main building, 290 South Center St, Westminster
Health on Wheels Mobile Clinic
Other:
Overall, how satisfied are you with the services you received today?
Very satisfied
Somewhat satisfied
Not satisfied or dissatisfied
Somewhat dissatisfied
Very dissatisfied
Clear selection
Did you have enough time to discuss your reproductive health needs and questions with your provider?
Yes
No
Clear selection
Did you have enough privacy during your visit with the nurse or provider?
Yes
No
Clear selection
Were you informed of a variety of contraceptive methods?
Yes
No
Not applicable
Clear selection
Was the use of your contraceptive method(s) of choice explained clearly to you?
Yes
No
Not applicable
Clear selection
Was the cost of your appointment:
Affordable - I can come back when I need to
Somewhat affordable - I can come back sometimes
Not very affordable - it will be hard for me to come back
Clear selection
Would you recommend a friend or family member to this clinic?
Yes
No
Not sure
Clear selection
How did you hear about our services?
Website
Social media
Healthcare provider
Friend or family member
Another agency
Outreach event
Promotional item or materials
Other:
Clear selection
We are always looking for ways to improve our services. Please share your suggestions, comments or concerns about your visit today.
Your answer
Your zip code
Your answer
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