Medication Therapy Management Survey

What is your pharmacy practice setting?

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* 1. What is your pharmacy practice setting?

Who completes the MTM services provided in your pharmacy? (Check all that apply)

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* 2. Who completes the MTM services provided in your pharmacy? (Check all that apply)

If MTMs are being performed by your pharmacy, what percentage is completed face-to-face? (Enter % in the box below)

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* 3. If MTMs are being performed by your pharmacy, what percentage is completed face-to-face? (Enter % in the box below)

What percentages of MTMs in your pharmacy are completed by each of the following companies? (Enter % in the box below)

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* 4. What percentages of MTMs in your pharmacy are completed by each of the following companies? (Enter % in the box below)

What challenges, as a pharmacist, do you encounter when delivering and completing MTM services for patients? (check all that apply)

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* 5. What challenges, as a pharmacist, do you encounter when delivering and completing MTM services for patients? (check all that apply)

If you provide MTM services, on average how many minutes do you spend on one MTM for the following actions?

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* 6. If you provide MTM services, on average how many minutes do you spend on one MTM for the following actions?

Would you be interested in hearing more about Well Street Care Management Network's MTM support service?

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* 7. Would you be interested in hearing more about Well Street Care Management Network's MTM support service?

Contact Information (Optional) Please complete if you would like to receive a small token of appreciation for completing this survey.

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* 8. Contact Information (Optional) Please complete if you would like to receive a small token of appreciation for completing this survey.

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