We want to hear from our supporters!
Pro-Choice Arizona is collecting information We want to learn about YOU, what part of the state is home for you, and any reproductive health care needs that are lacking in your community. You can choose to remain anonymous or share your contact information. None of your personal information will be shared outside the organization without your permission. We want to connect with supporters statewide.
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What city do you live in?
What county do you live in?
Not in Arizona
Are you involved in any progressive/social justice movements in your local community? If so, which one(s)?
We are seeking to partner with organizations around the state, but anyone is welcome to complete this survey regardless of their involvement.
Do you work in reproductive healthcare or have you in the past? (birthworker, doula, ob/gyn, maternal health provider, etc.)
What healthcare services are lacking in your immediate community? What needs does your community have that are not being met?
(for example: cancer screenings, free STI testing, counseling)
Culturally sensitive providers/clinics
Free STI testing
Information and/or interpretation services in preferred language
Telemedicine services (virtual doctors visits)
Have you ever had trouble accessing care for the following reproductive or sexual health needs?
birth control (pills, IUD, implant)
STI treatment or testing
uterine disorders (ex: endometriosis, adenomyosis, polycystic ovarian syndrome)
I'm not comfortable sharing.
Anything else you would like to share?
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This form was created inside of Pro-Choice Arizona.