“You’re a Busy Teenager” Opinion Survey

Please take a few moments to complete this survey after you’ve read through “You’re a Busy Teenager”. Your answers are anonymous. Your feedback will help to improve the tool.

Thanks for your time and feedback.

Questions marked with * are required

1 - Where did you find "You’re a Busy Teenager"? (Please check one answer)
  Hospital
Planned Parenthood
Dr’s Office/Clinic
Health Department
WIC Clinic
Family Member/Friend
Internet
School
Other, Please Tell Us
 
 
2 - I found the information interesting.
  Strongly Disagree
Disagree
Agree
Strongly Agree
 
3 - If a friend asked me what a Reproductive Life Plan was, I would be able to explain it.
  Strongly Disagree
Disagree
Agree
Strongly Agree
 
4 - I think it is important for me to make a Reproductive Life Plan.
  Strongly Disagree
Disagree
Agree
Strongly Agree
 
5 - The information helps me know what I can do now, while I’m young, to prepare for a healthy pregnancy in the future WHEN or IF I decide to have a baby.
  Strongly Disagree
Disagree
Agree
Strongly Agree
 
6 - Most likely, I will share this information with a friend.
  Strongly Disagree
Disagree
Agree
Strongly Agree
 
7 - Other comments or suggestions you would like to share:
 
Comments Or Suggestions:  
 
8 - What is your age
 
 
9 - Sex:
  Male
Female
 
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