PPO Client Feedback Form
The following questions are being asked to help us evaluate and fund our programming. Answering the questions is completely voluntary, and the information shared with us will be kept confidential.
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What day were you supported by PPO? *
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What time of day was it when you received support?
Please check all the apply. Were you supported through:
Do you remember the name(s) of who supported you?
During my interaction with PPO I felt supported in a non-judgmental and unbiased way.
Strongly Disagree
Strongly Agree
Clear selection
We discussed all of the sexual and reproductive health options that I was interested in exploring today (types of birth control, pregnancy options, etc.)
Strongly Disagree
Strongly Agree
Clear selection
My interaction with PPO has given me information and support that has helped me.
Strongly Disagree
Strongly Agree
Clear selection
What was the most helpful thing that was said or done for you during your interaction with PPO?
What would you change about, or add to, our Options Support Service?
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