The Northern Contraception, Sexual Health & HIV Service Survey

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* 1. Which of the following options best describes how you think of yourself?

Man (including trans man)

Non-binary

Woman (including trans woman)

Prefer not to say

If other, please state:

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* 2. Is your gender identity the same as you were assigned at birth?

Yes

Prefer not to say

Any comments, please state below

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* 3. Which of the following options best describes how you think of yourself?

Bisexual

Gay

Heterosexual/Straight

Lesbian

Pansexual

Queer

Prefer not to say

If other, please state:

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* 4. What is your age group?

0-15

16-24

25-34

35-44

45-54

55-64

65+

Prefer not to say

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* 5. What is your ethnicity?

African

Arabic

Bangladeshi

Black African

Black British

Caribbean

Chinese

Czech

Indian

Irish

Mixed / Multiple Ethnic Group

Pakistani

Polish

Romanian

White British

White and Asian

White and Black African

White and Black Caribbean

Any other Black background

Any other Asian background

Any other White background

Any other mixed background

Prefer not to say

Other Ethnic Group , please state below

We are keen to find out your opinions on the services currently available within Manchester so we would be grateful if you would help us by completing the following.

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* 6. Have you ever attended a sexual health clinic in Manchester?

Yes

Unsure

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* 7. If yes, which clinic(s) have you used? (Please tick all that apply)

Cheetham Hill Primary Care Centre

Harpurhey Health Centre

Newton Heath Sure Start Centre

North Manchester General Hospital

Stockport – Choices Centre

Stockport – Central Youth

The Hathersage Centre

Tameside – The Orange Rooms

Trafford - Limelight

Trafford - Partington

Trafford - Talkshop

Trafford - Urmston Clinic

Withington Community Hospital

Wythenshawe Forum

Other - please state:

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* 8. Thinking about the clinics that you have attended, how would you rate the overall quality of the care that you have received?

Excellent

Good

Adequate

Poor

Very poor

Please tell us why you answered the way you did?

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* 9. Thinking about your experiences using any of the Northern services can you tell us how you felt about the following aspects of the service?

	Definitely at all times	Most of the time	Occasionally	No not at all
The online booking forms are inclusive in their questions	The online booking forms are inclusive in their questions Definitely at all times	The online booking forms are inclusive in their questions Most of the time	The online booking forms are inclusive in their questions Occasionally	The online booking forms are inclusive in their questions No not at all
Home testing kits provided with the appropriate swabs or urine bottles	Home testing kits provided with the appropriate swabs or urine bottles Definitely at all times	Home testing kits provided with the appropriate swabs or urine bottles Most of the time	Home testing kits provided with the appropriate swabs or urine bottles Occasionally	Home testing kits provided with the appropriate swabs or urine bottles No not at all
Waiting areas and clinic rooms were designed in a gender neutral manner	Waiting areas and clinic rooms were designed in a gender neutral manner Definitely at all times	Waiting areas and clinic rooms were designed in a gender neutral manner Most of the time	Waiting areas and clinic rooms were designed in a gender neutral manner Occasionally	Waiting areas and clinic rooms were designed in a gender neutral manner No not at all
The toilets were gender neutral and had appropriate sanitary waste disposal	The toilets were gender neutral and had appropriate sanitary waste disposal Definitely at all times	The toilets were gender neutral and had appropriate sanitary waste disposal Most of the time	The toilets were gender neutral and had appropriate sanitary waste disposal Occasionally	The toilets were gender neutral and had appropriate sanitary waste disposal No not at all
The clinician and support staff showed respect and courtesy	The clinician and support staff showed respect and courtesy Definitely at all times	The clinician and support staff showed respect and courtesy Most of the time	The clinician and support staff showed respect and courtesy Occasionally	The clinician and support staff showed respect and courtesy No not at all
The reception and administrative staff showed respect and courtesy	The reception and administrative staff showed respect and courtesy Definitely at all times	The reception and administrative staff showed respect and courtesy Most of the time	The reception and administrative staff showed respect and courtesy Occasionally	The reception and administrative staff showed respect and courtesy No not at all
The advertising and health promotion displayed in the Northern Service clinics and online were appropriate and representative information was available	The advertising and health promotion displayed in the Northern Service clinics and online were appropriate and representative information was available Definitely at all times	The advertising and health promotion displayed in the Northern Service clinics and online were appropriate and representative information was available Most of the time	The advertising and health promotion displayed in the Northern Service clinics and online were appropriate and representative information was available Occasionally	The advertising and health promotion displayed in the Northern Service clinics and online were appropriate and representative information was available No not at all
The Northern Service as a whole provided you with access to all of the services you require	The Northern Service as a whole provided you with access to all of the services you require Definitely at all times	The Northern Service as a whole provided you with access to all of the services you require Most of the time	The Northern Service as a whole provided you with access to all of the services you require Occasionally	The Northern Service as a whole provided you with access to all of the services you require No not at all

If you have any comments or suggestions for improvement of the above, please state below

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* 10. Do you think a designated transgender/non binary sexual and reproductive health clinic would be useful?

Yes

Unsure

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* 11. What do you think would be a good name for this designated trans and gender diverse sexual and reproductive health clinic would be?

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* 12. We are keen to find out about any specific sexual and reproductive health services you would like to receive, please tick all that would interest you below.

(Please note, we will do our very best to provide a full and thorough service that provides the care you want but some of this will be subject to a commissioning request and funding availability.)

Sexual health screening

Cervical Smears

Vaccinations

Hormone therapy monitoring

PEPSE (Post Exposure Prophylaxis after Sexual Exposure)

PrEP (Pre-exposure Prophylaxis)

Contraception services

HIV Care

Other, please state below

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* 13. What would an excellent Sexual and Reproductive health service look like to you?

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* 14. Do you have any other comments about The Northern Service? Please let us know how you felt about your experiences, both good and bad in the box below and if you have any suggestions for the future.

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* 15. Would you be willing to be involved in helping shape the service development? If so please leave your name and contact details (phone number and/ or email address in the box below)

Name:

Tel number:

Email address:

The Northern Contraception, Sexual Health & HIV Service

Trans and Non Binary Service User Sexual Health Survey

Question Title

* 1. Which of the following options best describes how you think of yourself?

Question Title

* 2. Is your gender identity the same as you were assigned at birth?

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* 3. Which of the following options best describes how you think of yourself?

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* 4. What is your age group?

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* 5. What is your ethnicity?

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* 6. Have you ever attended a sexual health clinic in Manchester?

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* 7. If yes, which clinic(s) have you used? (Please tick all that apply)

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* 8. Thinking about the clinics that you have attended, how would you rate the overall quality of the care that you have received?

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* 9. Thinking about your experiences using any of the Northern services can you tell us how you felt about the following aspects of the service?

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* 10. Do you think a designated transgender/non binary sexual and reproductive health clinic would be useful?

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* 11. What do you think would be a good name for this designated trans and gender diverse sexual and reproductive health clinic would be?

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* 13. What would an excellent Sexual and Reproductive health service look like to you?

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* 14. Do you have any other comments about The Northern Service? Please let us know how you felt about your experiences, both good and bad in the box below and if you have any suggestions for the future.

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* 15. Would you be willing to be involved in helping shape the service development? If so please leave your name and contact details (phone number and/ or email address in the box below)