Items:

Please rate the health care provider you saw today with respect to the following qualities:

1. Respecting me as a person
2. Showing care and compassion
3. Letting me say what mattered to me about my birth control method
4. Giving me an opportunity to ask questions
5. Taking my preferences about my birth control seriously
6. Considering my personal situation when advising me about birth control
7. Working out a plan for my birth control with me
8. Giving me enough information to make the best decision about my birth control method
9. Telling me how to take or use my birth control method most effectively
10. Telling me the risks and benefits of the birth control method I chose
11. Answering all my questions

Response Options:
Poor - 1
Fair - 2
Good - 3
Very good - 4
Excellent - 5