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Pregnancy Ultrasound
STD Testing & Treatment
Free Post-Abortion Support
Reproductive Health Resources (FEMM)
Pregnant Student Support
Legacy Men’s Services
Men’s Support and Resources
Fatherhood Mentoring & Unplanned Pregnancy Support
Post-Abortion Recovery for Men
Momma Mentoring & Pregnancy Support
What to Expect
Abortion Pill Information
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Menu
Our Services
Pregnancy Tests
Pregnancy Ultrasound
STD Testing & Treatment
Free Post-Abortion Support
Reproductive Health Resources (FEMM)
Pregnant Student Support
Legacy Men’s Services
Men’s Support and Resources
Fatherhood Mentoring & Unplanned Pregnancy Support
Post-Abortion Recovery for Men
Momma Mentoring & Pregnancy Support
What to Expect
Abortion Pill Information
Locations
Request An Appointment
Locations
About Us
What to Expect
Staff
Alternatives in the News
Client Stories
Testimonials
Videos
Abortion
Parenting
Get Involved
Programs & Services
Our Mission & Vision
Church Engagement
Give Today
Events
Volunteer
Relationship Education
Merch Store
Employment Opportunities
Legislation Blog Posts
Counseling After Abortion Client Survey
Please select which service you are surveying
(Required)
Individual Counseling
Group Support
Name (optional)
First
Last
Location
Virtual
Denver
East Metro
Inverness
Other
Individual Counseling
Did your provider seem interested and curious about you and your needs?
Very
Mostly
Somewhat
Minimally
Uninterested
Other
Was your provider sensitive and respectful of your values, beliefs, and perspectives?
Very
Mostly
Somewhat
Minimally
Insensitive
Other
Did your provider offer and maintain a non-judgmental experience for you?
Very
Mostly
Somewhat
Minimally
No
Other
Was your provider empathetic and understanding?
Very
Mostly
Somewhat
Minimally
No
Other
To what extent did your provider help you learn skills that will help you in the future?
5 (high)
4
3
2
1 (low)
Other
Would you recommend your provider to a friend?
Yes
Maybe
No
Other
Would you return to us in the future if the need arises?
Yes
Maybe
No
Other
What feelings or emotions motivated you to make your initial appointment? Comparatively today, what feelings or emotions are you experiencing now?
What have you gained from your experience?
Please offer feedback on our facility and/or virtual experience.
Please provide any additional feedback that would help your provider improve.
Do you give us permission to use this completed exit questionnaire to promote our services?
Yes, but remove my name
Yes
No
Group Support
What were your main reasons for participating in the group experience? (check all that apply)
General support
I want to meet others
I want to listen to other stories
I want to help others
I want to get help from others
It's free
It's easy to attend/participate
I wanted to try a group experience
My therapist suggested it
I feel more comfortable in a group setting than individual counseling
Comments
Did your provider(s) seem interested and curious about each group participant and their individual needs?
Very
Mostly
Somewhat
Minimally
Uninterested
Other
Did your provider(s) show respect for your values, beliefs, and perspectives and those of the other group members?
Very
Mostly
Somewhat
Minimally
Insensitive
Other
Did your provider(s) offer and maintain a non-judgmental experience for the group?
Very
Mostly
Somewhat
Minimally
No
Other
Did your provider(s) ensure an empathetic and understanding group experience?
Very
Mostly
Somewhat
Minimally
No
Other
Did your provider(s) manage group dynamics adequately where everyone was given appropriate attention and space to process uniquely within the group?
Very
Mostly
Somewhat
Minimally
No
Other
Would you recommend this group to a friend or family member?
Yes
Maybe
No
Other
Consider the content/curriculum. Please offer feedback on what worked and what needs improvement. Please offer any content suggestions you have.
Consider your overall participation in the group. What have you gained most? What skills/tools will you implement into your everyday life?
Please offer feedback on our facility and/or your virtual experience.
Please provide any additional feedback that would help your provider(s) improve.
Do you give us permission to use this completed exit questionnaire to promote our services?
Yes, but remove my name
Yes
No
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