Availability of Prescribed Epinephrine

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* 1. Have you been unable to fill or refill a prescription for EpiPen, EpiPen Jr, or generic EpiPen or EpiPen Jr. within the last two months, due to a lack of adequate supply at your pharmacy?

I could not fill it at all

I could fill it, but only partially

I was able to fill it completely- SKIP TO QUESTION 3

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* 2. If you could not fill your prescription, were you able to with an alternate brand, and if so, which one?

Yes

No

If yes, specify below.

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* 3. Which device(s) were you trying to obtain?

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* 4. What pharmacy did you visit for this purchase?

Other (please specify)

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* 5. In what state is the pharmacy located?

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* 6. Comments?