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Section 1 of 10
Section 2 of 10
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Yes
No
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add "Other"
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Section 3 of 10
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Specialty prescription
Generic prescription
Over-the-counter
All the above
Don't know
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Section 4 of 10
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Always
Sometimes
Never
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Section 5 of 10
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1 - 2 times
3 - 4 times
5 - 6 times
7 or more times
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Section 6 of 10
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As needed
Morning
Night
Before meals
After meals
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Keep container nearby
Pill organizer
Note
Phone reminder
App
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Less than a week
1 week
2 weeks
Never
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Section 7 of 10
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Cigna
Aetna
Express Scripts
Walgreens
CVS Pharmacy
Kaiser Permanente
Walmart
Safeway
Costco
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In-Store Pickup
Delivery
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Always
Sometimes
Never
Don't know
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Section 8 of 10
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In person
Online
Phone call
Text
App
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