ZONNIC Post-Sample Survey – Pharmilink Sampling Program

Thank you for participating in the Pharmilink Sampling program and receiving ZONNIC samples. We are conducting this follow-up survey to gather your valuable feedback on your experience with ZONNIC and the Pharmilink Sampling Program. Your insights are crucial for understanding the impact of ZONNIC on your practice and for improving future initiatives.

This survey should take approximately 5 minutes to complete. Your responses will be kept confidential and analyzed anonymously. Participation is completely voluntary.

Question Title

* 1. How did you utilize the ZONNIC samples in your practice? (Select all that apply)

Provided to patients

Personal evaluation

Staff education

Displayed in waiting area

Discussed without providing

Did not use

Other

Question Title

* 2. Did you receive any direct feedback from patients who tried ZONNIC samples?

Yes, mostly positive

Yes, mixed feedback

Yes, mostly negative

No feedback

Not applicable

Question Title

* 3. Based on your experience or review, how would you rate your understanding of ZONNIC’s:

	1 Not good understanding	2	3	4	5 Very good understanding	N/A
Mechanism of action	Mechanism of action 1 Not good understanding	Mechanism of action 2	Mechanism of action 3	Mechanism of action 4	Mechanism of action 5 Very good understanding	Mechanism of action N/A
Intended use	Intended use 1 Not good understanding	Intended use 2	Intended use 3	Intended use 4	Intended use 5 Very good understanding	Intended use N/A
Perceived Benefits	Perceived Benefits 1 Not good understanding	Perceived Benefits 2	Perceived Benefits 3	Perceived Benefits 4	Perceived Benefits 5 Very good understanding	Perceived Benefits N/A
Risks/side effects	Risks/side effects 1 Not good understanding	Risks/side effects 2	Risks/side effects 3	Risks/side effects 4	Risks/side effects 5 Very good understanding	Risks/side effects N/A
Appropriate patient population	Appropriate patient population 1 Not good understanding	Appropriate patient population 2	Appropriate patient population 3	Appropriate patient population 4	Appropriate patient population 5 Very good understanding	Appropriate patient population N/A
Usage instructions	Usage instructions 1 Not good understanding	Usage instructions 2	Usage instructions 3	Usage instructions 4	Usage instructions 5 Very good understanding	Usage instructions N/A

Question Title

* 4. How has your overall perception of ZONNIC changed since receiving the samples?

Significantly more positive

Moderately more positive

No change

Moderately more negative

Significantly more negative

Significantly more positive

Moderately more positive

No change

Moderately more negative

Significantly more negative

Question Title

* 5. What factors most influenced your perception of ZONNIC after participating in the Pharmilink Sampling Program? (Select all that apply)

Personal experience

Patient feedback

Ease of use

Perceived effectiveness

Taste/flavor

Safety profile

Info provided

Peer discussion

Other

Question Title

* 6. How likely are you to recommend ZONNIC to patients, compared to other NRTs?

Much more likely

Somewhat more likely

Equally likely

Somewhat less likely

Much less likely

Much more likely

Somewhat more likely

Equally likely

Somewhat less likely

Much less likely

Question Title

* 7. To what extent do you agree with the following statements?

	1 - Strongly Disagree	2	3	4	5 - Strongly Agree
ZONNIC is a potentially useful NRT option	ZONNIC is a potentially useful NRT option 1 - Strongly Disagree	ZONNIC is a potentially useful NRT option 2	ZONNIC is a potentially useful NRT option 3	ZONNIC is a potentially useful NRT option 4	ZONNIC is a potentially useful NRT option 5 - Strongly Agree
Easy for patients to use	Easy for patients to use 1 - Strongly Disagree	Easy for patients to use 2	Easy for patients to use 3	Easy for patients to use 4	Easy for patients to use 5 - Strongly Agree
Effectively addresses cravings	Effectively addresses cravings 1 - Strongly Disagree	Effectively addresses cravings 2	Effectively addresses cravings 3	Effectively addresses cravings 4	Effectively addresses cravings 5 - Strongly Agree
I feel confident discussing it	I feel confident discussing it 1 - Strongly Disagree	I feel confident discussing it 2	I feel confident discussing it 3	I feel confident discussing it 4	I feel confident discussing it 5 - Strongly Agree
Can improve patient outcomes	Can improve patient outcomes 1 - Strongly Disagree	Can improve patient outcomes 2	Can improve patient outcomes 3	Can improve patient outcomes 4	Can improve patient outcomes 5 - Strongly Agree

Question Title

* 8. Are you open to being visited by a rep in person to learn more about ZONNIC?

Yes

Question Title

* 9. Please indicate the province in which you currently practice:

Question Title

* 10. Please provide your College of Physicians & Surgeons license number (not your billing #).
(NB. This is required to ship the gift card for completing both the pre-sample and post-sample surveys, to you.)

ZONNIC Post-Sample Survey – Pharmilink Sampling Program

Question Title

* 1. How did you utilize the ZONNIC samples in your practice? (Select all that apply)

Question Title

* 2. Did you receive any direct feedback from patients who tried ZONNIC samples?

Question Title

* 3. Based on your experience or review, how would you rate your understanding of ZONNIC’s:

Question Title

* 4. How has your overall perception of ZONNIC changed since receiving the samples?

Question Title

* 5. What factors most influenced your perception of ZONNIC after participating in the Pharmilink Sampling Program? (Select all that apply)

Question Title

* 6. How likely are you to recommend ZONNIC to patients, compared to other NRTs?

Question Title

* 7. To what extent do you agree with the following statements?

Question Title

* 8. Are you open to being visited by a rep in person to learn more about ZONNIC?

Question Title

* 9. Please indicate the province in which you currently practice:

Question Title

* 10. Please provide your College of Physicians & Surgeons license number (not your billing #).(NB. This is required to ship the gift card for completing both the pre-sample and post-sample surveys, to you.)

* 10. Please provide your College of Physicians & Surgeons license number (not your billing #).
(NB. This is required to ship the gift card for completing both the pre-sample and post-sample surveys, to you.)