JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Abuse and Violence Against Community Pharmacists
(email addresses are only used internally / as identifiers and will not be distributed or used for any other purposes)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Background Information
Age
*
20 - 24
25 - 34
35 - 44
45 - 54
55 - 65
Other:
Sex
*
Female
Male
Other:
Years in community pharmacy practice
*
Less than 1 year
1 - 5 years
6 - 10 years
11 - 20 years
Other:
Are you an intern pharmacist?
Yes
No
Clear selection
Educational Degree
*
D. Pharm
B.Sc Pharm
B. Pharm
M. Pharm
Pharm D
Other:
Race (select what applies to you, can be more than one selection)
*
White (non-hispanic)
Hispanic
Black (American)
Black (African)
Black (Other)
Asian (South)
Asian (Fareast)
Asian (Central)
Arab
Other:
Required
Country of Practice
*
Your answer
Practice Location
*
Urban
Rural
Suburban
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Michigan.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report