Medication Therapy Management Survey

* 1. What is your pharmacy practice setting?

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

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

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

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

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

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

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