PCC Survey - Pregnancy Care Clinic

Name *

Phone *

Email Address *

Are you male or female? *MaleFemale

If you (or your partner) were pregnant, would you be interested in prenatal, parenting or dad mentoring programs at the PCC? *YesNo

Do you think sex outside of a committed relationship is a big deal? *YesNo

Did you know 1 in 5 sexually active people in the U.S. have an STD? *YesNo

Did you know it’s possible to reverse the affects of the abortion pill if you (your partner) change your mind before the second dose? *YesNo

How do you prefer to make appointments (doctor, hair, etc)?Text the officeOnline schedulerCall the office

Survey