TARO-Acitretin – Physician Survey Please fill out this survey regarding your experience with our patient program materials and this website. This survey should take 5-8 minutes to complete. OK Question Title * 1. Is this your first time completing this survey? Yes No OK Question Title * 2. What role do you play? Specialist physician/Dermatologist /OBGYN General practitioner/Family physician Pharmacist Other (please specify) OK Question Title * 3. Is this the first time you have visited this website? Yes No OK Question Title * 4. Choose the reason(s) for your visit to this website. Check all that apply. Get information about psoriasis Get information about this medication (Taro-acitretin) Download patient materials Download forms and checklists Other (please specify) OK Question Title * 5. What suggestions do you have to help us improve the information provided in the program materials and on this website? OK Question Title * 6. When you prescribe Taro-acitretin for psoriasis, what materials do you always provide your patients? Check all that apply. Information about psoriasis Information about this drug (Taro-acitretin) Patient prevent pregnancy program components Other (please specify) OK Question Title * 7. Which feature(s) of the program, if any, acts as a barrier to you prescribing to all appropriate patients? Check all that apply. None. The program meets my needs and those of my patients Clarity of drug (Taro-acitretin) prescribing responsibilities Time required to comply with requirements for prescribing Presentation format of materials Testing requirements for patient compliance Have not used the program enough to comment Difficulty in accessing forms and other information Other (please specify) OK Question Title * 8. Do you agree to be contacted by a representative from Taro Pharmaceuticals Inc. about your answers to this survey? No Yes, please provide your first and last name, email and phone number OK Thank you for taking the time to complete this survey. This information will help us to provide further information and support for psoriasis patients in the future. OK DONE
