Medication Review Benefit Quiz

Privacy Information: We will not share your email with third parties and we will not contact you for follow up research purposes unless you explicitly consent. We will only use your e-mail address to send you a record of your answers and additional information about contacting a healthcare professional in your area. There is no obligation on your part after filling out this survey. We may aggregate results, including your anonymized information, for research purposes. See full details of our privacy policy.

How Much Could A Medication Review Help Me?

1. Do you have more than 3 medical conditions?*
- Yes
- No
2. Do you take 5 or more medications regularly?*
- Fewer than 5
- 5 to 11
- 12 or more
3. Do you take 12 or more medication doses each day?*
- Yes
- No
4. How many persons write prescriptions for you?*
- 1
- 2 to 4
- 5 or more
5. Have you had more than 3 changes to your medications in the last year?*
- Yes
- No
6. When was your last appointment for an overall review of all of your medications?*
- Never
- Within last 5 years
- More than 5 years
7. Have you wondered if you are experiencing medication side effects?*
- Yes
- No
8. Are you 65 years of age or more?*
- Yes
- No
9. Do any of your drugs need monitoring with blood tests? (common examples are warfarin, digoxin, carbamazepine, lithium, phenytoin but there are many others)*
- Yes
- No
10. Do you take non prescribed medications (including painkillers) or supplements regularly?*
- Yes
- No
Email address to send record of results*
Enter Email Confirm Email
What country do you reside in?*
State*
Province*
Country*
Follow-up
The ASCP and the Research Team at McMaster University's Department of Family Medicine is working to make this tool even more useful. May we contact you in the next few months to ask you a few questions about your experience? We will not give your email address to anyone else.
- Yes, you may contact me.
- No, please don't contact me.

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