| 1. Do you plan to become pregnant? When? |
| 2. Are you currently having sex with a male partner? |
| 3. What have you used before to prevent pregnancy? |
| 4. What did you like/dislike about the method(s)? |
| 5. Are you a good pill taker? |
| 6. How often did you forget to use the method? |
| 7. Are there any methods you have heard about and would like to try? |
| 8. Is sex usually planned or spontaneous? |
| 9. Is protection from sexually transmitted infections important considering your life situation? |
| 10. Is cost an issue? Does your health insurance plan cover any birth control method? |
