*1.How would you rate your overall experience with the LARC Service ?(Required.)

Excellent

Good

Fair

Poor

2.How would you rate the professionalism and friendliness of our staff?

Excellent

Good

Fair

Poor

3.Were you given clear and comprehensive information about the LARC options available to you?

Yes

No

Other (please specify)

4.How would you rate the comfort and privacy of the consultation and procedure rooms?

Excellent

Good

Fair

Poor

5.How would you rate your experience during the LARC procedure?

Excellent

Good

Fair

Poor

6.Were you satisfied with the follow-up care and support provided?

Yes

No

7.Do you have any suggestion for how we can improve our LARC service?

8.Please share any additional comments or feedback you may have

9.Would you recommend this service to friends and family if they require similar care or treatment ?

Yes

No