Dr's Information

First Name*
Last Name*

Street Address*
City*

State*
PIN Code*

Email Address*
Telephone Number*

Mobile Number*
Consultancy Places*

Specialization*
Registration Number*

  Questionnaire

Kindly suggest Medication Adherence Program will improve your patient sustainability?*
Select one: YesNo
Do you feel your patients are very much discipline in the case of taking medicine?*
Select one: YesNo

Kindly Suggest Calenderized Packaging will help your patient to adhere in medication?, Select one: YesNo


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Name of Person Completing This Form*
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