Medication evaluation program feedback form

Clinic name
Medication
Number of patients prescribed

Based on the feedback you received, please rate this medication on a scale of 1 to 5, where 1 is low and 5 is high:
Q1. How do you rate the perceived efficacy of the medication
Q2. How do you rate the perceived quality of the medication
Q3. How do you rate your patient’s overall satisfaction with the medication
Q4. How likely are you to prescribe this medication, for an appropriate patient, in the future
If you were to prescribe the medication again, what would be the most likely symptom or condition?
Other comments

While research into the efficacy and effects of plant-based medicines, including medicinal cannabis, for certain treatments is increasing, it is currently in its early days. Patients should always talk to a health professional for advice on their unique requirements before making any decisions about treatment options. For the latest, most accurate information on medicinal cannabis, head to the TGA website: https://www.tga.gov.au/medicinal-cannabis-guidance-documents

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1300 122 662
info@cannatrek.com

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