Medication Therapy Management Survey Medication Therapy Management Survey Question Title * 1. What is your pharmacy practice setting? Grocery store Health-system inpatient Health-system outpatient Independent Large chain (more than 5) pharmacies Small chain (5 or less) pharmacies Question Title * 2. Who completes the MTM services provided in your pharmacy? (Check all that apply) Any employee pharmacist who is available to conduct the MTM in person Any employee pharmacist who is available to conduct the MTM over the phone One dedicated employee pharmacist performs all of our MTMs in person One dedicated employee pharmacist performs all of our MTMs over the phone Contracted pharmacist(s) who only perform face-to-face clinical services for our pharmacy Contracted pharmacist(s) that only performs telephonic clinical services for our pharmacy A telephonic service provider does all of our MTMs I do not know who does our MTMs MTMs are not done in our pharmacy Question Title * 3. If MTMs are being performed by your pharmacy, what percentage is completed face-to-face? (Enter % in the box below) Question Title * 4. What percentages of MTMs in your pharmacy are completed by each of the following companies? (Enter % in the box below) Mirixa: Outcomes: Symphonia: Wholesaler: Other: Question Title * 5. What challenges, as a pharmacist, do you encounter when delivering and completing MTM services for patients? (check all that apply) Don't know how to provide MTM services Don't have the time to do them Don't have the staff to do them Don't get paid enough for my time Patients don't want the service Can't get the patient to schedule an appointment Patients don't show up for their appointment Other (please specify) Question Title * 6. If you provide MTM services, on average how many minutes do you spend on one MTM for the following actions? Research/participation: Talking to the patient: Billing: Question Title * 7. Would you be interested in hearing more about Well Street Care Management Network's MTM support service? Yes (Please provide your contact information below) No Question Title * 8. Contact Information (Optional) Please complete if you would like to receive a small token of appreciation for completing this survey. Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Done