Needle Exchange Program Survey

This survey gives you a chance to tell us how we are doing and how we can improve the services we provide. Please take a few minutes to complete this survey. Your responses are CONFIDENTIAL and ANONYMOUS. You may bring this survey home to complete and bring back or mail back to the Health Unit or to the clinic. You may also fill out this survey on our website at www.healthunit.org.

1. Do you use the Health Unit's Needle Exchange Program?

Yes (continue with this page)
No (skip to next page 2)

IF YOU ANSWERED "YES" FOR QUESTION 1, CONTINUE TO THIS SECTION.
IF YOU ANSWERED "NO" FOR QUESTION 1, DO NOT CONTINUE THIS SECTION AND GO TO PAGE 2.

2. How did you find out about the program?

3. Why do you use the Needle Exchange Program? Please check all that apply.

Safe environment
Costs too much to buy syringes
Feeling of responsibility to protect others
Fear of contracting Hepatitis C or HIV
Other (please specify):

4. A) How easy is it to access the needle exchange program?

Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult

4.B) Please explain why.

5. How can we make it easier for you and others to access the Needle Exchange Program?

6. How do you normally dispose of your used supplies (inhalation and/or injection)?

7. a) Are you worried about contracting Hepatitis C?

7. b) Please describe why:

8. a) Do you experience any negative feelings or reactions from the public because they see you as a user?

Yes
No
Don't know

8. b) Please describe why:

9. a) Do you experience any negative feelings or reactions from other users?

Yes
No
Don't know

9. b) Please describe why:

10. Please provide comments or suggestions on how the Health Unit can provide better services for you.

END OF SURVEY FOR PAST AND CURRENT USERS OF THE NEEDLE EXCHANGE PROGRAM .

IF YOU ARE A PAST OR CURRENT USER OF THE NEEDLE EXCHANGE PROGRAM PLEASE GO TO THE BOTTOM OF PAGE 2 AND SUBMIT. DO NOT COMPLETE PAGE 2.