1. Default Section

* 1. My medical providers, nurses and other clinics staff treat me with respect and dignity.

* 2. I feel my care and personal information are protected and kept confidential.

* 3. I trust that my medical providers can take care of my needs and answer my concerns.

* 4. I can obtain appointments that are convenient me.

* 5. I have a chance to ask questions; EIS staff listens to me and I receive answers I can understand.

* 6. Referrals to other providers/specialists outside of the EIS Program are well coordinated.

* 7. I feel my HIV/AIDS care is well coordinated with other providers and specialists I see.

* 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.

* 9. I am encouraged to participate in my healthcare; my care and treatments are explained to me.

* 10. I receive and understand instructions and training for my medications.

* 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

* 12. Please tell us what suggestions you have to improve care and services for EIS patients