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Instructions

Please read questions carefully as certain parameters must be met prior to moving on to the next question

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* 2. Participant Name or Identifier

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* 3. Age of participant

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* 4. Email Address of participant (optional)

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* 5. How does the participant identify themselves? (select current category)

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* 6. Does the participant have access to the internet?

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* 7. How much time during the session was dedicated to Hepatitis C?

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* 8. How many one on one Circle sessions did this participant attend?

0 Total number of Circle Sessions 20
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i We adjusted the number you entered based on the slider’s scale.

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* 9. Was this participant referred by another Circle Model participant?

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* 10. Did the participant receive HCMSG educational print materials?

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* 11. Was the participant tested?

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* 12. Does the participant consider the education and support they received about Hepatitis C and harm reduction in terms of safer drug use practices to be

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* 13. Does the participant consider the education and support they received about Hepatitis C and harm reduction in terms of safer sex practices to be

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* 14. The participant was cured of Hepatitis C

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* 15. The participant was informed of the importance of follow-up after being cured of Hepatitis C

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