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Receive's Free Patient Education Print Booklets

The goal of's booklets is to inform and serve your clients and patients. Your feedback on this brief survey helps us get these guides in the hands of people living with HIV across the U.S. Thanks for helping to make an effective resource for the HIV community!

Organization, clinic or program name:

Primary contact name:

Job title:

Mailing address:

Email address:

Phone number:

How large is the HIV-positive population that your organization serves?

If "More than 500," please give an estimate:

What percentage of men, women and transgender people does your organization serve? (If you have no clients of a given gender, feel free to write "none" or "N/A.")

Men (Percentage:
Women (Percentage:
People of transgender experience (Percentage:

What percentage of heterosexual, bisexual, gay/MSM and/or lesbian/WSW individuals does your organization serve? (If you have no clients of a given sexual orientation, feel free to write "none" or "N/A.")

Gay or bisexual men/MSM (Percentage:
Lesbian or bisexual women/WSW (Percentage:
Heterosexual women (Percentage:
Heterosexual men (Percentage:

Race/ethnic makeup of the population your organization serves (check all that apply):

Asian (Chinese, Japanese, Indonesian, Korean, etc.)
Black (African American, African, etc.)
Caucasian (white)
Middle Eastern
Native American
Native Hawaiian/Other Pacific Islander
South Asian (Indian, Pakistani, Bangladeshi, etc.)
Other (Please specify: )

Do most of your clients speak a language other than English as their primary language?

If "Yes," please specify the language(s):

Information on Your Booklet Needs

If you can remember receiving's booklets in the past, please rate their quality and usefulness:

How do you plan to distribute's booklets?
Place them in a waiting room/common area
Providers will hand them to patients individually during appointments
Other (Please specify: )

Would you be interested in distributing cards with our Web address and social media information?

If "Yes," where would you distribute them?

About how many copies of a given booklet do you think your organization might need?

If "More than 200," please specify an amount:

Would you be interested in receiving booklets on the following topics? (Check all that apply.)
Basics for People Newly Diagnosed With HIV
Pregnancy and HIV
Safer Sex for People Living With HIV
HIV and Gay or Bi Men / MSM
HIV and Heterosexual Men
HIV, Exercise and Nutrition
Remembering to Take Your HIV Meds
HIV and Mental Health
HIV and Substance Abuse
Aging With HIV
Coping With Side Effects
HIV and Other STDs
Basics of Understanding Your Lab Tests
Other topics (Please specify: )

What general type of information do your clients need most? (Check all that apply.)
Personal stories and advice from others living with HIV who have had similar experiences
Clinical information written in an accessible manner

Could low literacy be a potential barrier to your clients' access of booklets with a lot of text?

If "Yes," what other ways might your clients want to receive print information
(e.g., more graphics, or larger text/less text per page):

Is there anything else you would like to share regarding your organization's educational information needs?

We hope to be able to distribute booklets this year. In the meantime, note that all of our booklets -- including photos and graphics -- are available online, all the time! You can read or print out pages from each booklet at

Thank you for participating in our survey.