1 How well does TCV keep illegal drug activity away from the clinic? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
2 Does the location of the clinic provide you with privacy and confidentiality? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
3 The speed and length of the medication line is: 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
4Are the nurses usually friendly and considerate to you? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
5 How satisfied are you with the services you receive from the nurse? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating) es?
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6 Does the doctor put you at ease and make you feel comfortable during your visit? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
7Does the doctor treat you with dignity and respect? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
8 Overall, how satisfied are you with the services you receive from the doctor? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
9 Getting in touch with your counselor is: 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
10 How frequently do you meet with your counselor? daily 2 or 3 times a week 1 time a week 2 or 3 times a month 1 time a month less than 1 time a month
11What referrals have you requested? HIV/AIDS team Vocational services Medical services Psychiatric services Groups Nutritional services Parent-child services Psychological testing / services other (please specify)
11a Was your counselor able to provide these referrals? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
12 Is counseling helping you? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
13 The confidentiality and privacy of your counseling sessions are: 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
14 Does your counselor treat you with dignity and respect? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
15 Overall, how satisfied are you with the services your receive from your counselor? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
16 Who is your counselor? (optional)
17 The fee you pay for services is: 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
18 Would you be interested in other groups being offered at TCV? Yes No
If so, what type of group would you be interested in:
19 How long have you been in methadone treatment total? less than 3 months 3 months to 1 year 1 year to 3 years 3 years to 6 years 6 years to 9 years 9 years to 12 years 12 years to 18 years 18 years to 24 years over 24 years
20 How did you find out about this program? TV Friend Referral from another clinic "Grapevine" Family Doctor Phone book TCV patient Do not remember
21 If you knew someone with a substance abuse problem, would you refer he/ him to thisprogram for help? Yes No
22 Overall, how satisfied are you with access to this program? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
23 Overall, how satisfied are you with this program’s responsiveness to your concerns? 1 2 3 4 5 6 7 (1= Worst rating 7=best rating)
24 How could TCV improve its responsiveness to your concerns
Services include, but are not limited to: Medical evaluations and referrals; individual, group, and specialized counseling; case management; crisis intervention; and the provision of comprehensive coordination of care among other providers.
TCV will be an integrated healthcare provider with accessibility to individuals and families whose lives have been impacted by opiate dependence. We will also continue to cultivate a team of competent, compassionate personnel who are dedicated to individualized care and committed to continuously improving services. We will use ongoing research and development to maintain an environment open to learning and to provide education to the community we serve. TCV will reflect a spirit of collaboration, which embraces teamwork and communication.
