Items:

During your consultation today [within the past month], did the provider:

OR

When you first adopted your current method, did the provider:When you first adopted your current method, did the provider:

1. Ask about whether you would like to have a/nother child?
2. Ask about when you would like to have a/nother child?
3. Ask about your previous family planning experience?
4. Ask about your family planning method preference?
5. Provide information about different family planning methods?
6. Talk about possible side effects or problems with the method you select?
7. Tell you what to do if you experience any side effects or problems with the method you selected?
8. Talk about warning signs associated with the method you selected?
9. Talk about the possibility of switching to another method if the method you selected was not suitable?
10. Provide information while strongly encouraging one method?
11. Talk about the methods that protect against HIV/AIDS and STIs?
12. Talk about how to use the method you selected
13. Talk about how the method you selected works?
14. Tell you when to return to the health facility for a follow-up visit?
15. Tell you about other sources of family planning supply?
16. Give you an appointment card for follow-up visit?
17. When meeting with the provider during your visit, do you think other clients could see you?
18. When meeting with the provider during your visit, do you think other clients could hear what you said?
19. During your visit, would you say that you were treated well by the provider?
20. Did the provider allow you to ask questions?
21. Did the provider answer all of your questions to your satisfaction?
22. Do you believe that the information that you shared about yourself with the provider will be kept confidential?

Response Options:
Yes - 1
No - 0