You can always press Enter⏎ to continue
Big Country Derm Pharmacy Provider Survey
Hi there, please fill out and submit this form.
5
Questions
START
1
I send 80% or more of the prescriptions I write to Big Country .
*
This field is required.
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Previous
Next
Submit
Press
Enter
2
Sending prescriptions to Big Country saves my staff time.
*
This field is required.
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Previous
Next
Submit
Press
Enter
3
Sending prescriptions to Big Country saves my patients money.
*
This field is required.
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Previous
Next
Submit
Press
Enter
4
My team finds it difficult for patients to agree to send their medication to Big Country.
*
This field is required.
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Disagree Strongly
Disagree
Neither Disagree or Agree
Agree
Agree Strongly
N/A
Previous
Next
Submit
Press
Enter
5
The primary issue that could be changed for my office to send more prescriptions to Big Country is...
TextSize
Created with Sketch.
Huge
Large
Normal
Small
Bold
Created with Sketch.
Italic
Created with Sketch.
Underline
Created with Sketch.
Underline Copy
Created with Sketch.
Ok
NumberList Copy 2
Created with Sketch.
quote
Created with Sketch.
Break
Created with Sketch.
Image
Created with Sketch.
Ok
Smiley
Created with Sketch.
Previous
Next
Submit
Press
Enter
Should be Empty:
Big Country Derm Pharmacy Provider Survey
[Edit]
Question Label
1
of
5
See All
Go Back
Submit
.5eb0700878c5d1.44111956.png){kind=logo}
