How would you rate this drug's overall effectiveness:

1      2     3     4     5     

  How would you rate this drug's side effects?

1      2     3     4     5     

  Did the drug perform in a timely manner?

1      2     3     4     5     

  Did this drug deliver good value for the money?

1      2     3     4     5     

  How long have you been taking this drug:   Days Months Years

   Would you recommend this drug:     Yes     No    

Additional Comments


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