Treatment Update 2010 from the CROI Survey

1. What is the topic of the program or programs you just watched? (click multiple boxes, if applicable)

What is the topic of the program or programs you just watched? (click multiple boxes, if applicable) HIV Treatment	Anti-Retrovirals	Metabolic Issues	Side-Effects	Women's HIV Issues	Hepatitis Co-Infection	Prevention/ Microbicides	Advocacy/ Activism
Other (please specify)

2. What is the Date that you watched this program?

	MM		DD		YYYY
Month/Day/Year	What is the Date that you watched this program? Month/Day/Year Month	/	Day	/	Year

*
3. Did you find the information in this program useful?

	Not Useful	Somewhat Useful	Useful	Very Useful	Extremely Useful
Choose one:	*Did you find the information in this program useful? Choose one: Not Useful	Choose one: Somewhat Useful	Choose one: Useful	Choose one: Very Useful	Choose one: Extremely Useful

4. Will this program affect any of your future healthcare decisions about yourself or for others?

	Will not affect	Will affect somewhat	Will affect	Will have a large effect	Will have a major effect
Choose one:	*Will this program affect any of your future healthcare decisions about yourself or for others? Choose one: Will not affect	Choose one: Will affect somewhat	Choose one: Will affect	Choose one: Will have a large effect	Choose one: Will have a major effect

5. Would you be interested in watching another such program in the future?

	Will definitely not Watch		Will Probably Watch		Will definitely watch
Choose one:	*Would you be interested in watching another such program in the future? Choose one: Will definitely not Watch	Choose one:	Choose one: Will Probably Watch	Choose one:	Choose one: Will definitely watch

6. Do you have any suggestions on other programs issues you may be interested in?

Do you have any suggestions on other programs issues you may be interested in?

7. Any other comments you may have?

Any other comments you may have?

8. What is your interest in this subject?

What is your interest in this subject? I am a Provider of HIV services

I am HIV Positive myself

I am both a provider and HIV postive

9. Where in the US do you live?

Where in the US do you live? City/Town:
State:

10. If you wish to be contacted about future programs, please enter an email address:
(email addressees are kept confidential & are not shared)

If you wish to be contacted about future programs, please enter an email address: (email addressees are kept confidential & are not shared) Email Address:

Treatment Update 2010 from the CROI
Exit this survey

1. Default Section

1. What is the topic of the program or programs you just watched? (click multiple boxes, if applicable)

2. What is the Date that you watched this program?

*
3. Did you find the information in this program useful?

4. Will this program affect any of your future healthcare decisions about yourself or for others?

5. Would you be interested in watching another such program in the future?

6. Do you have any suggestions on other programs issues you may be interested in?

7. Any other comments you may have?

8. What is your interest in this subject?

9. Where in the US do you live?

10. If you wish to be contacted about future programs, please enter an email address:
(email addressees are kept confidential & are not shared)

Treatment Update 2010 from the CROIExit this survey

1. Default Section

1. What is the topic of the program or programs you just watched? (click multiple boxes, if applicable)

2. What is the Date that you watched this program?

*3. Did you find the information in this program useful?

4. Will this program affect any of your future healthcare decisions about yourself or for others?

5. Would you be interested in watching another such program in the future?

6. Do you have any suggestions on other programs issues you may be interested in?

7. Any other comments you may have?

8. What is your interest in this subject?

9. Where in the US do you live?

10. If you wish to be contacted about future programs, please enter an email address:(email addressees are kept confidential & are not shared)

Treatment Update 2010 from the CROI
Exit this survey

*
3. Did you find the information in this program useful?

10. If you wish to be contacted about future programs, please enter an email address:
(email addressees are kept confidential & are not shared)