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* 1. Gender of patient (Please select one answer)
 
Male
 
Female
 
 
 
* 2. Approximate age of patient. (Please select one answer)
 
Under 40
 
40 – 64
 
65 or older
 
 
 
* Q3. What type of assistance did the patient need? Please scroll down to see all of the options. (Please select all that apply)
 
Location of product
 
Dosage instructions
 
Needed information / guidance on managing their condition
 
Product recommendation
 
Needed advice about prescription medications
 
Diagnosis of a minor ailment (allergy, rash, cold/flu, etc. )
 
Needed information on a home healthcare item (e.g. cane, supports, etc.)
 
Other
 

 
 
 
* Q4. With what types of product(s) did you assist the patient? Please scroll down to see all of the options. (Please select all that apply)
 
Analgesics, Antihistamines
 
Cough & Cold
 
Gastrointestinal
 
Diabetic
 
Vitamins, Minerals, Natural Health, Weight / Diet Products
 
Other
 
None of the above

 
 
 
* Q5. Did you use the Medication database on the iPad during this consultation? (Please select one)
 
Yes
 
No
 
 
 
* Q6. Do you agree or disagree that the Medication database added value to the patient consultation? (Please select one)
 
Disagree
 
Neither
 
Agree
 
 
 
* Q7. Did the Medication Database result in your changing the following? (Please select all that apply)
 
Changed the product recommendation you would have made
 
Changed the dosage that you would have recommended
 
Changed the information/advice that you would have provided to the patient
 
None of the above

 
 
 
* Q8. Does this patient currently have his/her prescriptions with Shoppers Drug Mart? (Please select one)
 
Yes
 
No
 
Don’t know
 
 
 
* Q9. In your opinion based on this consult how much more likely would the patient be to switch to Shoppers Drug Mart as their main pharmacy to fill their prescriptions? (Please select one)
 
Not likely
 
More likely
 
Much more likely
 
Don’t know
 
 
 
* Q10. You mentioned, the patient would not be more likely to switch to Shoppers Drug Mart as their main pharmacy to fill their prescriptions. Why? (Please select all that apply)
 
Good relationship with existing pharmacy
 
Existing pharmacy is closer to his/her home/clinic
 
Have been with his/her pharmacy for many years
 
Existing pharmacy offers better pricing
 
Other
 
Don't know

 
 
 
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