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Table 2 Online appointment request form

From: The HER Salt Lake media campaign: comparing characteristics and outcomes of clients who make appointments online versus standard scheduling

Field Data Format Rationale
Name Client entered First and Last name To set an appointment and establish if the client is a new or returning patient
Date of Birth Client entered MM/DD/YYYY To verify age eligibility for initiative (16–45 years)
Current method of contraception Selected current method from drop-down menu: condoms; IUD; implant; pill; patch; ring; shot; none; other To verify eligibility for a walk-in appointment or need for an appointment with a provider
Desired method of contraception Client selected desired method from drop-down menu: condoms; IUD; implant; pill; patch; ring; shot; none; other To verify eligibility for a walk-in appointment (user-dependent method) or need for an appointment with a provider (IUD or implant removal/insertion) and also to verify eligibility for no-cost contraception through the contraceptive initiative study i.e. starting or switching a method
Preferred appointment date Client entered MM/DD/YYYY of preferred appointment date Scheduling staff would make every effort to schedule an appointment for the date preferred by the potential client. Clinic business days varied by location
Preferred appointment time Client entered time and A.M./P.M. of preferred appointment Scheduling staff would make every effort to schedule an appointment for the time preferred by the potential client. Clinic business hours varied by location
Preferred appointment location Client selected location from drop down menu of three clinic options Scheduling staff would make every effort to schedule an appointment for the location preferred by the potential client
Phone number Client entered phone number XXX-XXX-XXXX Scheduling staff contacted potential clients within 24 h or the next business day to confirm a requested appointment or to find another time if the requested appointment was not possible
E-mail Client entered e-mail address Scheduling staff contacted potential clients within 24 h or the next business day to confirm a requested appointment or to find another time if the requested appointment was not possible