CLINIC SERVICES SATISFACTION SURVEY
We are interested in your opinions about your visit today and about the care you received from the health professionals and staff. Please rate each of the following things about this visit (mark one answer for each item).
| How satisfied are you with how the staff: | Not at all satisfied | Somewhat satisfied | Satisfied | Very satisfied | Extremely satisfied |
|---|---|---|---|---|---|
| Respected me as a person | |||||
| Showed care and kindness | |||||
| Listened to what mattered to me about my abortion | |||||
| Gave me an opportunity to ask questions | |||||
| Considered my circumstances when giving me information | |||||
| Worked out an abortion plan with me | |||||
| Helped me to make decisions about my abortion method | |||||
| Explained advantages of different abortion methods | |||||
| Explained risks of different abortion methods | |||||
| Answered all of my questions clearly | |||||
| Made my medical services as comfortable as possible | |||||
| Took my preferences about my birth control seriously | |||||
| Treated me without bias or judgment |
Do you have any suggestions for us?