Clinician Survey for Future Prescribers of YoniFit

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* 4. I am a:

MD / DO

APP (PARN / PA / CNM)

Other (please specify)

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* 5. My specialty is:

Family medicine

Internal medicine

OBGYN / Women's health

Urogynecology

Other (please specify)

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* 6. My practice type is:

Private practice solo provider

Private practice 1-4 providers

Private practice 5+ providers

Academic medicine

Community health center / FQHC

Indian health service

Hospital based clinic

HMO employee eg Kaiser

Other (please specify)

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* 7. My practice setting is:

Rurual

Suburban

Urban

Telehealth

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* 8. How many patients do you see in a typical day?

Less than 10

10-20

More than 20

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* 9. Please estimate the percent of your patients who are: (do not have to equal 100%)

	0%	25%	50%	75%	100%
Privately insured	Privately insured 0%	Privately insured 25%	Privately insured 50%	Privately insured 75%	Privately insured 100%
Medicaid / Medicare insured	Medicaid / Medicare insured 0%	Medicaid / Medicare insured 25%	Medicaid / Medicare insured 50%	Medicaid / Medicare insured 75%	Medicaid / Medicare insured 100%
Uninsured	Uninsured 0%	Uninsured 25%	Uninsured 50%	Uninsured 75%	Uninsured 100%

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* 10. Please estimate the percent of your patients who are: (do not have to equal 100%)

	0%	25%	50%	75%	100%
Adolescents, 10-25 yo	Adolescents, 10-25 yo 0%	Adolescents, 10-25 yo 25%	Adolescents, 10-25 yo 50%	Adolescents, 10-25 yo 75%	Adolescents, 10-25 yo 100%
Adult, premenopausal	Adult, premenopausal 0%	Adult, premenopausal 25%	Adult, premenopausal 50%	Adult, premenopausal 75%	Adult, premenopausal 100%
Adult, postmenopausal	Adult, postmenopausal 0%	Adult, postmenopausal 25%	Adult, postmenopausal 50%	Adult, postmenopausal 75%	Adult, postmenopausal 100%

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* 11. Please estimate the percent of your patients who are: (do not have to equal 100%)

	0%	25%	50%	75%	100%
White / Caucasian	White / Caucasian 0%	White / Caucasian 25%	White / Caucasian 50%	White / Caucasian 75%	White / Caucasian 100%
Black / African American	Black / African American 0%	Black / African American 25%	Black / African American 50%	Black / African American 75%	Black / African American 100%
Latino / Hispanic	Latino / Hispanic 0%	Latino / Hispanic 25%	Latino / Hispanic 50%	Latino / Hispanic 75%	Latino / Hispanic 100%
Asian	Asian 0%	Asian 25%	Asian 50%	Asian 75%	Asian 100%
American Indian and Alaska Native	American Indian and Alaska Native 0%	American Indian and Alaska Native 25%	American Indian and Alaska Native 50%	American Indian and Alaska Native 75%	American Indian and Alaska Native 100%
Native Hawaiian and Other Pacific Islander	Native Hawaiian and Other Pacific Islander 0%	Native Hawaiian and Other Pacific Islander 25%	Native Hawaiian and Other Pacific Islander 50%	Native Hawaiian and Other Pacific Islander 75%	Native Hawaiian and Other Pacific Islander 100%

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* 12. What is your current knowledge level about YoniFit?

No knowledge

Very familiar with the product

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 13. What is your interest level in YoniFit?

No interest

Very interested

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 14. What percent of your patients complain of stress urinary incontinence (SUI)?

50%

100%

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 15. How often do you prescribe pessaries for your patients?

Never

Routinely

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 16. If you decided to prescribe YoniFit, would anyone in your institution need to approve it before you did? (Assume FDA approval)

Yes (please explain process)

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* 17. Does your clinic or hospital have an in house pharmacy where you could stock and dispense YoniFit from?

Yes

Other (please specify)

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* 18. Education: We are committed to educating you and your office on the use and data behind YoniFit. How would you prefer to receive education? Select all that apply:

On demand videos / webinars

1:1 zoom calls

Group zoom calls with other prescribers / clinics

In person

Emailed materials

Mailed materials (hard copy)

Other (please specify)

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* 19. Marketing: We would love the chance to promote our product in a way that works in your office. Which of the following would you like? Select all that apply:

Prescription pads with instructions for patients

Wall posters

Patient pamphlets

Information cards for patients

Other (please specify)

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* 20. Thank you! We will send you updates periodically and will be in contact once we are FDA approved. Please note here if:
- You have any additional comments.
- You would like to be contacted about investing in YoniFit.
- You would like to be contacted for any other reason.
Thank you for your time and we look forward to sharing our product with you.

Clinician Survey for Future Prescribers of YoniFit

Demographics, knowledge, and interest in YoniFit

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* 1. Name:

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* 2. Email:

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* 3. Practice name and location:

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* 4. I am a:

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* 5. My specialty is:

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* 6. My practice type is:

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* 7. My practice setting is:

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* 8. How many patients do you see in a typical day?

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* 9. Please estimate the percent of your patients who are: (do not have to equal 100%)

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* 10. Please estimate the percent of your patients who are: (do not have to equal 100%)

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* 11. Please estimate the percent of your patients who are: (do not have to equal 100%)

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* 12. What is your current knowledge level about YoniFit?

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* 13. What is your interest level in YoniFit?

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* 14. What percent of your patients complain of stress urinary incontinence (SUI)?

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* 15. How often do you prescribe pessaries for your patients?

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* 16. If you decided to prescribe YoniFit, would anyone in your institution need to approve it before you did? (Assume FDA approval)

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* 17. Does your clinic or hospital have an in house pharmacy where you could stock and dispense YoniFit from?

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* 18. Education: We are committed to educating you and your office on the use and data behind YoniFit. How would you prefer to receive education? Select all that apply:

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* 19. Marketing: We would love the chance to promote our product in a way that works in your office. Which of the following would you like? Select all that apply:

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