Contraceptive Options Video and Questionnaire

Contraceptive Methods

This video was created to assist women at the University of New Hampshire make well informed decisions regarding contraceptive options. Health Services carries many of the options presented in film but not all of them. All women who are first-time users of contraceptives, and seeking a prescription at UNH Health Services, are required to view this video in its entirety and complete the post-questionnaire below.

If you are having technical difficulties watching the video, please call (603) 862-3823. If you have any questions about any of the material presented, ask your provider at your follow-up appointment

Post-Questionnaire

We are only asking you to answer these questions so that we can determine how effective the Contraceptive video is. You will not be graded. After completing the questionnaire you will be able to view your results and the correct answers.

Student ID Number: *

The acronym for symptoms of serious effects to hormonal birth control is ACHES. Can you identify what each letter stands for?: *

Aches, Chest Pain, Heart Pain, Ear Aches, Sexual Discomfort

Abdominal Pain, Chest Pain/Shortness of Breath, Headaches, Eye Problems, Sexual Discomfort

Abdominal Pain, Chest Pain/Shortness of Breath, Headaches, Eye Problems, Severe Leg Pain

Aches in Body, Coughing, Headaches, Easy Bowel Movements, Sleepiness

Within what time frame is Emergency Contraception (EC) most effective?: *

12 Hours

24 Hours

72 Hours

One Week

There are 11 health benefits of hormonal contraceptives that were mentioned in the video. How many can you list?: *

What new information did you learn from watching the video? Please list 3 things.: *

Emotional Wellness	Environmental Wellness	Financial Wellness	Intellectual Wellness
Occupational Wellness	Physical Wellness	Social Wellness	Spiritual Wellness

Health Services

Contraceptive Options Video and Questionnaire

Contraceptive Methods

Post-Questionnaire

Primary links

The 8 Dimensions of Wellness