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* 1. Your gender:

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* 2. Your ethnic group:

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* 3. Your race:

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* 4. How many months have you come here for services?

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* 5. Something about this place makes me feel nervous.

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* 6. I never know quite what to expect from staff here.

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* 7. The staff think they know what is best for me, more than I do.

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* 8. I'm learning new skills here.

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* 9. I would recommend this program to anyone who has had bad experiences in their lives.

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* 10. I get to choose the kinds of services I receive.

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* 11. I don't feel like I can trust anyone here.

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* 12. When I come here, I feel safe.

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* 13. In deciding about my recovery plans, I feel like the staff are in charge.

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* 14. I never feel as though the staff appreciate who I am and what I can do.

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* 15. The staff do things for me I'd rather do for myself.

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* 16. I'm worried that information about my care may be shared with the wrong people.

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* 17. If a woman got emotional in a group, she would be considered a drama queen.

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* 18. The signs make it clear where I can find exits, restrooms and offices.

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* 19. I feel that my privacy is highly respected.

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* 20. Staff here understand that men often have a hard time talking about their feelings.

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* 21. I have no control over what services I receive.

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* 22. No one here notices it when I am in distress.

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* 23. If a man cried in a group here, he would probably get teased.

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* 24. Staff here know that I have strengths and skills.

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* 25. Every time I come here, I learn something new.

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* 26. The staff here really understand how to help people who have had bad experiences in their lives.

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* 27. The way this building is decorated-flooring, furniture, wall paint and artwork-has a calming, inviting effect.

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* 28. I expect that staff will do what they say they are going to do.

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* 29. I feel like the staff have all the power and the people receiving the services have none.

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* 30. Staff here are helping me to feel better about myself as a man or a woman.

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* 31. The people here give me the tools I need to help me change.

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* 32. The services provided don't address my concerns and needs.

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* 33. The staff listen to what I say I need.

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* 34. Staff here understand that relationships are important to women.

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* 35.  Some people who come here for services are forced to do things they don't want to do.

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* 36. The staff tell me when to come for appointments without asking what time is good for me.

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