Creating New Ryan White Legislation Consumer Survey

1. What services do you currently receive?

What services do you currently receive? Medical Medical Case Management Mental Health Substance Abuse Housing	Early Intervention services Home Health Care Treatment Adherence Dental Medical Nutrition
Other (please specify)

2. Of the services that you receive and checked above, which ones do you currently receive through Ryan White funded programs?

Of the services that you receive and checked above, which ones do you currently receive through Ryan White funded programs? Home Health Care Medical Medical Case Management Mental Health Substance Abuse Housing	Early Intervention Services Treatment Adherence Dental Medical Nutrition Don't Know________
Other (please specify)

3. How did you gain access to these services?

How did you gain access to these services? Self Medical Case Management	Other Case Management Friend
Other (please specify)

4. What is the average time frame between requesting an appointment actually seeing your provider?

What is the average time frame between requesting an appointment actually seeing your provider? Same day Less than a week One week	Two weeks One month Three months
Other (please specify)

5. How do you get to your appointments? (check all that apply)

How do you get to your appointments? (check all that apply) walk drive taxi/cab	public transportation friend
Other (please specify)

6. How many service providers do you have?

How many service providers do you have? one two three	four five
Other (please specify)

7. How Happy are you in general with the services your receive?

How Happy are you in general with the services your receive? very happy

happy

somewhat happy

somewhat unhappy

unhappy

8. Are you on any medications for your HIV/AIDS?

Are you on any medications for your HIV/AIDS? yes

9. Are you on antiretroviral therapy?

Are you on antiretroviral therapy? yes

10. How do you get your medications?

How do you get your medications? Go to pharmacy Pharmacy delivery By mail	Clinic Hospital
Other (please specify)

11. How is your medication paid for? (check all that apply)

How is your medication paid for? (check all that apply) Insurance RW-ADAP Self-Pay	Drug company patient assistance program Medicaid Medicare
Other (please specify)

12. Do you or have you had problems getting medications?

Do you or have you had problems getting medications? yes	no
Other (please specify)

13. Do you have childcare for when you are attending services?

Do you have childcare for when you are attending services? yes	no
Other (please specify)

14. Does your family receive any assistance as it relates t how you access services?

Does your family receive any assistance as it relates t how you access services? yes	no
Other (please specify)

15. In what type of prevention services have your participated?

In what type of prevention services have your participated?

16. What would you change about the way you access services?

What would you change about the way you access services?

17. If you could change one thing about your healthcare, what would it be?

If you could change one thing about your healthcare, what would it be?

18. What would you keep the same?

What would you keep the same?

19. What do you want policy makers to know about when it comes to accessing services?

What do you want policy makers to know about when it comes to accessing services?

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