Exit this survey Client Satisfaction Survey 1. Default Section Question Title * 1. My medical providers, nurses and other clinics staff treat me with respect and dignity. Agree Disagree (Please describe why you disagree) Question Title * 2. I feel my care and personal information are protected and kept confidential. Agree Disagree (Please describe why you disagree) Question Title * 3. I trust that my medical providers can take care of my needs and answer my concerns. Agree Disagree (Please describe why you disagree) Question Title * 4. I can obtain appointments that are convenient me. Agree Disagree (Please describe why you disagree) Question Title * 5. I have a chance to ask questions; EIS staff listens to me and I receive answers I can understand. Agree Disagree (Please describe why you disagree) Question Title * 6. Referrals to other providers/specialists outside of the EIS Program are well coordinated. Agree Disagree (Please describe why you disagree) Question Title * 7. I feel my HIV/AIDS care is well coordinated with other providers and specialists I see. Agree Disagree (Please describe why you disagree) Question Title * 8. If I choose, my other care givers (family, partners, friends and support organizations) have the oppurtunity to participate in my EIS Program care plan. Agree Disagree (Please describe why you disagree) Question Title * 9. I am encouraged to participate in my healthcare; my care and treatments are explained to me. Agree Disagree (Please describe why you disagree) Question Title * 10. I receive and understand instructions and training for my medications. Agree Disagree (Please describe why you disagree) Question Title * 11. Please rate the services that you receive from the EIS Program Low Below Average Average Above Average High I rate the care and services I receive I rate the care and services I receive Low I rate the care and services I receive Below Average I rate the care and services I receive Average I rate the care and services I receive Above Average I rate the care and services I receive High Question Title * 12. Please tell us what suggestions you have to improve care and services for EIS patients Done