Men’s Clinic Questionnaire

1) How many locations does your clinic have?*

1-5

5-15

15-30

30+

2) How do your patients receive their medications - Select all that apply*

in-office administration

office pick-up

mail

other

3) Do you currently utilize compounded medications in your treatment options? *

yes

no

if so, what types? - Select all that apply.

1) Injections

2) IVs - Pellets

3) Tablets/capsules

4) Topical

4) On a scale of 1 to 5, how happy are you with your current treatment options?*

(Optional) If you could change one thing about your current treatment offerings, what would it be?

Last step! Let us know how to best contact you:

Name*

First

Last

Title:

Phone

Email*

Preferred method of contact:

E-mail

Phone

Men's Clinic Questionnaire