Family Planning Client Exit Interview
Date: Facility Name:
Interviewer:
Asking one client at a time, please read the following questions aloud:
What service did you receive today?
Note: (If client indicates she did not receive FP services, thank her for her time and discontinue the interview.)
Are you willing to answer a few questions about the service you received today? This is not a test. We are trying to learn from the people who use family planning services so that we can be able to do our work in a better way. We will not share any information with anyone in a way that identifies you. We only have a few questions and this should only take a few minutes of your time.
YES NO
1. Are you satisfied with the service you received today? / Y N2. Did the provider give you information on a range of methods? / Y N
3. Did you get the method that you wanted? / Y N
4. Did the health worker teach you how to use the method you were given? / Y N
5. Did the health worker talk to you about side effects with that method? / Y N
6. Do you feel the health worker allow enough time to answer your questions? / Y N
7. Did the health worker give you a date when you should come back either for more family planning or for a check-up? / Y N
8. Were you treated with courtesy today? / Y N
9. Do you feel you have to wait too long to be cared for today? / Y N
10. Please tell us anything you think we need to know in order to improve the family planning service.
Thank you very much for your time. This information is very helpful for us. And thank you for choosing to attend the family planning clinic.