DOAC Practice Feedback Form

DOAC Formulary Review Service Feedback Form
Practice Name*
Name and Position

Full NamePosition
Using the scale below, please tick the most appropriate response:
5 = Excellent, 4 = Good, 3 = Fair, 2 = Poor, 1 = Very Poor
How do you rate the initial contact from MMS® regarding the service?

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2

3

4

5

1 is Very Poor, 5 is Excellent
How would you rate the overall competency of the MMS® Pharmacist?

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2

3

4

5

1 is Very Poor, 5 is Excellent
Please rate the relevance of the MMS Pharmacist DOAC Review service to support your practice priorities and/or patient care? e.g. DOAC therapy medicines optimisation.

1

2

3

4

5

1 is Very Poor, 5 is Excellent
Please provide further details if you have rated any aspect of the service as ‘Excellent’ or ‘Very Poor’
Any additional comments or suggestions?
Please verify your submission*
Your comments may be used in our future marketing/ testimonials, please tick the box if you are happy with this*

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Thank you for completing, your feedback is greatly appreciated.
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DOAC Formulary Review Service Feedback Form