Name
*
First Name
Last Name
Country of Practice:
*
Select Profession:
*
Physician
Nurse
PA/NP
Pharmacist
Specialty of Focus:
*
Nephrology
Cardiology
General Medicine
Pharmacy
Other
How many patients with CKD do you treat each month?
*
0 - 10
11 - 20
21 - 30
31 - 50
50+
Do you currently prescribe SGLT2 inhibitors to patients with CKD regardless of whether they have T2D?
*
Yes
No, diabetics only
After listening to this program, will your use of SGLT2 inhibitors in patients with CKD change?
*
Yes, increase
Yes, decrease
No, stay essentially the same
Please rate your impression of this program, from 1 (poor) to 5 (excellent).
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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