Main Survey

FDA DTC Survey
Rev: 06/13/16

National Survey of Prescription Drug Advertising
Thank you for taking part in this survey, your contribution is important to
us.
This survey asks about prescription drug advertising you may have seen on TV, the Internet or in
a magazine and how it might affect your health-care choices. The survey will take about 20
minutes to complete.
Your address was randomly selected from a list of residential addresses to ensure that everyone
in the country has the same chance of being chosen.
Taking part is voluntary and you do not have to answer any questions you don’t want to. We
respect your privacy. Your personal information will remain private to the fullest extent of the
law. Your personal information will not be linked to your answers or used in any report.
The survey is being conducted by Westat, a survey research organization, on behalf of the U.S.
Food and Drug Administration (FDA). If you have any questions about this study, including why
it is being conducted or how the results will be used, please contact us at XXX XXX XXXX or
email XXX.

To begin the survey, enter the 4-character access code that was provided in
your letter or postcard we mailed to you. [ENTER NUMBER]

1

FDA DTC Survey
Rev: 06/13/16

[INCLUDE PROGRESS BAR FOR ALL CASES]
1. How old are you? [AGE: Age]
__ years [Screen out if age is less than 18 years]
2a. Including yourself, how many adults (age 18 or older) usually live in your household?
[HHSIZE: Number adults in HH]
[ENTER NUMBER, SINGLE VALUE, RANGE 1-20]
2b. Are you… [SEX: Gender]
__ Male
__ Female
3. In general, would you say your health is… [HEALTH: Perceived Health]
__ Excellent
__ Very good
__ Good
__ Fair
__ Poor
This survey will ask about conversations you have had with your health care provider about
prescription drugs. “Health care provider” includes a medical doctor, nurse, or physician
assistant.
This survey will also ask about your use of the Internet. Think about all the ways you access the
Internet, such as using a computer, phone, or tablet.
4. How long has it been since the last time you saw a health care provider where you talked
about a health condition or concern of your own, not for a child or parent or someone
else? We’re interested in your last non-emergency room visit. [LASTHCP: Recent Health
Visit]
__ Within the last week
__ Within the last month
__ 1-3 months ago
__ 4-6 months ago
__ 7 months to 1 year ago
__ More than 1 year ago
__ Never

2

FDA DTC Survey
Rev: 06/13/16

Some of the following questions ask about prescription drugs. You can only get prescription
drugs with a health care provider’s prescription.
5. Which of the following products does the Food and Drug Administration--the FDA-approve before they are sold to consumers? [FDA Authority Knowledge] [DO NOT
RANDOMIZE]
a. Over-the-counter drugs
[FDA_OTC]
b. Dietary supplements,
including vitamins,
minerals, and herbal
remedies [FDA_DIET]
c. Prescription drugs
[FDA_RX]

__Yes

__ No

__Don’t know

__Yes

__ No

__Don’t know

__Yes

__ No

__Don’t know

6. In the last three months, do you recall seeing or hearing any ads (advertisements) for
prescription drugs? [M3EXPOS: DTC Ad Exposure]
__ Yes
__ No (Skip next question)
__ Not sure (Skip next question)
7. In the last three months, have you seen, read, or heard ads for prescription drugs in any of
the following ways: [DTC Ad Exposure: Amount] [RANDOMIZE]
a. On TV
(television)
[M3_TV]
b. On the radio
[M3_RADIO]
c. In a magazine or
newspaper
[M3_PT]
d. On the Internet
[M3_WEB]
e. In a letter, flyer,
or announcement
in the mail
[M3_MAIL]

__Yes

__No

__Yes

__No

__Yes

__No

__Yes

__No
(Skip next
question)
__No

__Yes

3

FDA DTC Survey
Rev: 06/13/16

8. In the last three months, have you seen a prescription drug advertised on: [DTC Ad
Exposure: Online] [RANDOMIZE]
a. A search engine, like Google or Bing
[WEB_SRCH]
b. Social media, like Twitter or Facebook
[WEB_SN]
c. An online banner ad, appearing at the
top, bottom or side of your screen
[WEB_BANR]
d. A streaming service, like Hulu
[WEB_STRM]

__Yes

__No

__Yes

__No

__Yes

__No

__Yes

__No

e. Where else on the Internet have you seen prescription drug ads? [WEB_OT2] [MAY
DELETE OR REPLACE WITH CLOSED-ENDED QUESTION AFTER PILOT]
[ENTER VERBATIM RESPONSE]
9. In the last three months, have you watched a video online about a prescription drug at any
of the following types of websites? [DTC Ad Exposure: Online] [DO NOT
RANDOMIZE]
a. A video sharing website, like YouTube
[VID_YT]
b. A prescription drug’s website [VID_RX]
c. A social networking website, such as Facebook
or Twitter [VID_SN]
d. A health information website, like
WebMD.com or MayoClinic.org [VID_HI]
e. On any other type of website [VID_OTH]

__Yes

__No

__Yes
__Yes

__No
__No

__Yes

__No

__Yes

__No

[PILOT ONLY; IF ANSWERED YES TO VID_OTH, THEN ASK:] On what other type of
websites did you watch a video about a prescription drug? [VID_OT2]
[ENTER VERBATIM RESPONSE]
10. Have you ever looked on the Internet for information about prescription drugs? [INFO:
DTC Ad Exposure: Online Information Seeking]
__ Yes
__ No (Skip next question)

4

FDA DTC Survey
Rev: 06/13/16

11. Have you ever looked for information about a prescription drug on any of the following
types of websites? [DTC Ad Exposure: Online Information Seeking] [RANDOMIZE,
BUT INFOOTH ALWAYS LAST]
a. A prescription drug's website [INFORX]
b. A general health website, such as WebMD.com or Mayoclinic.org
[INFOHLT]
c. A government website, such as FDA.gov, NIH.gov or
Healthfinder.gov [INFOGOV]
d. A website for a medical association, such the American Diabetes
Association or American Heart Association [INFOORG]
e. A patient community website, such as PatientsLikeMe.com
[INFOCOM]
f. A drug rating website, such as DrugRatingz.com [INFORATE]
g. Social networking websites, such as Facebook or Twitter
[INFOSN]
h. Video sharing websites, such as Youtube or Vimeo [INFOVID]
i. A blog [INFOBLOG]
j. An online discussion, Internet forum, or message board about
health care [INFOBRD]
k. A general information website, such as Wikipedia [INFOWIKI]
l. Any other type of website [INFOOTH]

__Yes
__Yes

__No
__No

__Yes

__No

__Yes

__No

__Yes

__No

__Yes
__Yes

__No
__No

__Yes
__Yes
__Yes

__No
__No
__No

__Yes
__Yes

__No
__No

[PILOT ONLY; IF ANSWERED YES TO INFOOTH, THEN ASK:] On what other websites
did you look for information about a prescription drug? [INFOOT2]
[ENTER VERBATIM RESPONSE]
12. Have you ever seen an ad on the Internet for a prescription drug you were especially
interested in? [WBEXPO: DTC Ad Exposure: Online]
__ Yes
__ No (Skip next two questions)
__ Don’t know (Skip next two questions)

5

FDA DTC Survey
Rev: 06/13/16

Thinking about the last time you saw an ad on the Internet for a prescription drug you were
especially interested in,
13. As best you can remember, how much, if any, of the information about the drug's benefits
did you see? Would you say you saw: [WBEXPO_B: DTC Ad Exposure: Online]
__ All of the information
__ Almost all of the information
__ About half of the information
__ Only a little of the information
__ None of the information
__ Don't know
14. As best you can remember, how much, if any, of the information about the drug's risks or
side effects did you see? Would you say you saw: [WBEXPO_R: DTC Ad Exposure:
Online]
__ All of the information
__ Almost all of the information
__ About half of the information
__ Only a little of the information
__ None of the information
__ Don't know
[PILOT ONLY] Using your own words, please tell us what you think this question was asking.
[WBEXPO_S]
[ENTER VERBATIM]
Next are a few questions about prescription drug advertising you may have seen in printed
magazines or newspapers.
15. Have you ever seen an ad in a magazine or newspaper for a prescription drug you were
especially interested in? Exclude ads in online magazines and newspapers. [PTEXPO:
DTC Ad Exposure: Print]
__ Yes
__ No (Skip next two questions)
__ Don’t know (Skip next two questions)

6

FDA DTC Survey
Rev: 06/13/16

[PILOT ONLY; IF ANSWERED YES TO PTEXPO, THEN ASK:] When was the last time you
saw an ad in a magazine or newspaper for a prescription drug that you were especially interested
in? [PTEXPO2]
__ Within the last week
__ Within the last month
__ 1-3 months ago
__ More than 3 months ago
Ads for prescription drugs in magazines and newspapers usually provide additional information
on the page following the main ad. This additional information gives more details about the drug.
Thinking about the last time you saw an ad in a printed magazine or newspaper for a prescription
drug you were especially interested in,
16. As best you can remember, how much, if any, of the main ad for that drug did you read?
Would you say you read: [PTEXPO_M: DTC Ad Exposure: Print]
__ All of the information
__ Almost all of the information
__ About half of the information
__ Only a little of the information
__ None of the information
__ Don't know
17. As best you can remember, how much, if any, of the additional information on the page
following the main ad did you read? Would you say you read: [PTEXPO_S: DTC Ad
Exposure: Print]
__ All of the information
__ Almost all of the information
__ About half of the information
__ Only a little of the information
__ None of the information
__ Don't know

7

FDA DTC Survey
Rev: 06/13/16

Next, here are a few questions about prescription drug advertising you may have seen on TV.
18. Here is a list of different types of information that may or may not appear in TV ads for
prescription drugs. Have you ever seen TV ads for prescription drugs that contained
information about: [DTC Ad Exposure: TV Elements] [DO NOT RANDOMIZE]
a. The benefits of the drug [TVEXPBEN]
b. The medical condition treated by the drug
[TVEXPCON]
c. Directions for use of the drug [TVEXPDIR]
d. Who could take the drug [TVEXPWHO]
e. Questions to ask a doctor about the drug
[TVEXPQ]
f. What to do in case of overdose
[TVEXPOD]
g. The risks or side effects of the drug
[TVEXPRSK]
h. Who should not take the drug
[TVEXPNOD]
i. How to get more information about the drug
or the medical condition treated by the drug
[TVEXPINF]

__Yes
__Yes

__No
__No

__Yes
__Yes
__Yes

__No
__No
__No

__Yes

__No

__Yes

__No

__Yes

__No

__Yes

__No

[PILOT ONLY; IF ANSWERED YES TO TVEXPDIR, THEN ASK:] What directions for use
of the drug were described in the prescription drug ads you saw on TV? [TVEXPDI2]
[ENTER VERBATIM RESPONSE]
19. Prescription drugs advertised on TV provide only limited information about risks or side
effects. If you wanted to obtain additional information, how likely would you be to use
the following sources: [RANDOMIZE]
a. The prescription drug’s
website [SEEK_RX]
b. A toll-free number
maintained by the
manufacturer
[SEEK_CAL]
c. A print ad that appears
in a magazine on most
newsstands [SEEK_PT]
d. Talking to a health care
provider [SEEK_DR]

__Very
likely
__Very
likely

__Somewhat
likely
__Somewhat
likely

__Not too
likely
__Not too
likely

__ Not at all
likely
__Not at all
likely

__Very
likely

__Somewhat
likely

__Not too
likely

__Not at all
likely

__Very
likely

__Somewhat
likely

__Not too
likely

__Not at all
likely

8

FDA DTC Survey
Rev: 06/13/16

20. Now think about the prescription drug ads you have seen on the Internet, in print, or on
TV.
Has an ad for a prescription drug ever caused you to look for more information, for
example, about the drug,your health or that of a friend or family member, or the medical
condition treated by the drug? [LOOKINFO: Behavior: Information Seeking]
__ Yes
__ No (Skip next two questions)
__ Don’t know (Skip next two questions)
21. What information did you look for? Information about: Check all that apply. [Behavior:
Information Seeking] [DO NOT RANDOMIZE]
__ A prescription drug you considered taking [LOOKINF1]
__ A prescription drug you were already taking [LOOKINF2]
__ A prescription drug you considered may be helpful for a friend or family member
[LOOKINF3]
__ A prescription drug a friend or family member was taking [LOOKINF4]
__ A medical condition treated by an advertised drug [LOOKINF5]
__ Something else (specify _______________________) [LOOKINF6], [LOOKIN_S]:
22. Did you look for further information: (Check all that apply) [Behavior: Information
Seeking] [RANDOMIZE, BUT ASK LOOKSR10 LAST]
__ In a reference book [LOOKSRC1]
__ In a magazine or newspaper [LOOKSRC2]
__ On the Internet [LOOKSRC3]
__ By asking a friend, relative, or neighbor [LOOKSRC4]
__ By calling the 1-800 number in the ad [LOOKSRC5]
__ By talking to a pharmacist [LOOKSRC6]
__ By talking to your doctor [LOOKSRC7]
__ By talking to a nurse [LOOKSRC8]
__ By talking to a doctor other than your own doctor [LOOKSRC9]
__ By doing something else (specify_________________) [LOOKSR10; LOOKSR_S]
23. If you saw or heard an ad for a drug that treats a condition that was bothering you, how
likely would you be to talk to your health care provider about the drug? [LTALKDR:
Behavioral Intention: Information Seeking]
1
Very likely

2
Somewhat
likely

3
Neither
likely nor
unlikely
9

4
Somewhat
unlikely

5
Very
unlikely

FDA DTC Survey
Rev: 06/13/16

24. As a result of seeing or hearing an ad for a prescription drug, have you ever talked with
a health care provider about a specific prescription drug you saw or heard advertised?
[TALKDRRX: Behavior: Physician Interaction]
__ Yes
__ No (Skip questions 26-27)
__Don’t know (Skip questions 26-27)
25. As a result of seeing or hearing an ad for a prescription drug, have you ever talked with
a health care provider about a medical condition or illness that you had not talked to a
health care provider about before? [TALKDRMC: Behavior: Physician Interaction]
__ Yes
__ No
__Don’t know
For the next two questions, please think of the most recent conversation you had with a health
care provider about a prescription drug you saw or heard advertised.
26. Did you specifically ask a health care provider to prescribe the drug you saw or heard
advertised? [ASKDR: Behavior: Physician Interaction]
__ Yes
__ No
__Don't know
27. Did the health care provider… (Check all that apply) [Behavior: Physician Interaction]
[DO NOT RANDOMIZE] [CONSISTENCY CHECK DRRECNOD VS DRRECRX
AND DRRECOTD]
__ Recommend lifestyle changes, such as getting more exercise or changes in diet
[DRRECCHG]
__ Give you a prescription for the drug you saw or heard advertised [DRRECRX]
__ Give you a prescription for a different drug [DRRECOTD]
__ Not give you any prescription at all [DRRECNOD]

10

FDA DTC Survey
Rev: 06/13/16

28. Prescription drug advertising has caused me to: [Behavior: Physician Interaction]
[RANDOMIZE]
a. Question the advice of my health care provider [RXPQUEX]
__ Yes
__ No
b. Experience conflict with a health care provider [RXPCONFL]
__ Yes
__ No
c. Talk with my health care provider about symptoms I’ve experienced [RXSYMP]
__ Yes
__ No
d. Talk with my health care provider about drug side effects I’ve experienced [RXSE]
__ Yes
__ No

11

FDA DTC Survey
Rev: 06/13/16

29. If a health care provider refused to prescribe a brand name drug you asked for, how likely
would you be to look for a different health care provider ? [LDRCHNG: Behavioral Intention:
Physician Interaction]
1
Very likely

2
Somewhat
likely

3
Neither
likely nor
unlikely

4
Somewhat
unlikely

5
Very
unlikely

30. Have you ever refused to take or stopped taking a prescription drug because of the side
effects you saw or heard in advertising? [STOPSEFF: Behavior: Compliance]
__ Yes
__ No
__Don’t know
To what extent do you agree or disagree with the following statements: [RANDOMIZE
BELAWARE THRU BELWORRY]
31. Ads for prescription drugs help make me aware of new drugs. [BELAWARE: DTC
Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

4
Disagree
somewhat

5
Disagree
strongly

32. Ads for prescription drugs do not give enough information about the possible benefits and
positive effects of using the drug. [BELNOBEN: DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

4
Disagree
somewhat

5
Disagree
strongly

33. Ads for prescription drugs do not give enough information about the possible risks and
negative effects of using the drug. [BELNORSK: DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree
12

4
Disagree
somewhat

5
Disagree
strongly

FDA DTC Survey
Rev: 06/13/16

34. Ads for prescription drugs make the drugs seem better than they really are.
[BELSMBTR:DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

4
Disagree
somewhat

5
Disagree
strongly

35. Ads for prescription drugs make it seem like a doctor is not needed to decide whether a
drug is right for me. [BELNODR: DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

4
Disagree
somewhat

5
Disagree
strongly

36. Ads for prescription drugs help me make better decisions about my health. [BELDEC:
DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

4
Disagree
somewhat

5
Disagree
strongly

37. Ads for prescription drugs help me have better discussions with my health care provider
about my health. [BELDISC: DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

13

4
Disagree
somewhat

5
Disagree
strongly

FDA DTC Survey
Rev: 06/13/16

38. Ads for prescription drugs encourage me to look for information about potentially
serious medical conditions I might be at risk of developing. [BELLKINF: DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

4
Disagree
somewhat

5
Disagree
strongly

39. Ads for prescription drugs make it seem like the drug will work for everyone.
[BELWORK: DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

4
Disagree
somewhat

5
Disagree
strongly

40. Ads for prescription drugs make me worry about my health. [BELWORRY: DTC Beliefs]
1
Agree
strongly

2
Agree
somewhat

3
Neither agree
nor disagree

14

4
Disagree
somewhat

5
Disagree
strongly

FDA DTC Survey
Rev: 06/13/16

41. How much do you trust prescription drug advertising: [Trust in DTC] [RANDOMIZE]
a. On TV
[TRUSTTV]
b. On the radio
[TRUSTRAD]
c. On the Internet
[TRUSTWEB]
d. In a magazine
or newspaper
[TRUSTPT]
e. In a letter,
flyer, or
announcement in
the mail
[TRUSTML]

__ Not at all

__Slightly

__Somewhat

__A lot

__ Not at all

__Slightly

__Somewhat

__A lot

__ Not at all

__Slightly

__Somewhat

__A lot

__ Not at all

__Slightly

__Somewhat

__A lot

__ Not at all

__Slightly

__Somewhat

__A lot

42. In a drug ad there can be words that describe how a drug works (for example: "some
people said their pain was completely better") and there can be numbers (such as "26% of
people said their pain was completely better"). How important is it to you that drug ads
show how well a drug works in numbers? [BELNUM_B: DTC Beliefs: Quantitative
Information]
__ Extremely important
__ Very important
__ Somewhat important
__ A little important
__ Not important at all
43. How important is it to you that drug ads show the chance of risks or side effects in
numbers? [BELNUM_R: DTC Beliefs: Quantitative Information]
__ Extremely important
__ Very important
__ Somewhat important
__ A little important
__ Not important at all

15

FDA DTC Survey
Rev: 06/13/16

44. When the FDA approves a prescription drug, it means that… [FDA Authority
Knowledge] [RANDOMIZE]
a. The drug will help everyone who uses it
[APR_HALL]
b. The drug offers benefits that are greater than
the risks [APR_BGTR]
c. The drug will help most people who use it
[APR_HMST]
d. The drug will cure the condition for which it
is prescribed [APR_CURE]
e. The drug is safe and won’t harm someone
who uses it [APR_SAFE]

__Yes

__No

__Don’t know

__Yes

__No

__Don’t know

__Yes

__No

__Don’t know

__Yes

__No

__Don’t know

__Yes

__No

__Don’t know

[Begin Experiment. Randomize participants to view either the Votrea or the Plevoral ad and
questions about Votrea or Plevoral. The Plevoral language is denoted in blue.]
Next, we will show you an ad for a new prescription drug, circled in yellow below. After you've
read the ad we will ask you some questions about it.
45. [ONLINE PARTICIPANTS ONLY] Were you able to view the ad for Votrea (Plevoral)?
[VIEW]
__ Yes
__ No (Skip to debriefing)
__ Not sure (Skip to debriefing)
46. Is the Food and Drug Administration (FDA) required to approve ads like this before they
can be used in advertising campaigns? [FDAAPRV]
__ Yes
__ No
__ Don’t know
The ad includes statements explaining what the drug does and how well it works, circled in
yellow below.
47. Is FDA required to approve those statements before they can be used in an advertising
campaign? [FDACLAIM]
__ Yes
__ No
__ Don’t know
16

FDA DTC Survey
Rev: 06/13/16

The ad includes a graph (an image) explaining what the drug does and how well it works, circled
in yellow below.
48. Is FDA required to approve the graph (image) before it can be used in an advertising
campaign? [FDAIMG]
__ Yes
__ No
__ Don’t know
The ad also includes statements about the risks of the drug, circled in yellow below.
49. Is FDA required to approve those statements before they can be used in an advertising
campaign? [FDARISK]
__ Yes
__ No
__ Don’t know
[Debriefing] The purpose of these questions is to understand how people think about prescription
drug information. In order to get an unbiased reaction to this information, we created a brand for
this study. Votrea (Plevoral) is not a real product and it is not available for sale. Please see your
healthcare professional for questions about high cholesterol.
[End Experiment]
50. In a typical week, how many hours do you use the Internet? [WWWHR: Internet Use]
__ hours
51. How often do you need to have someone help you when you read instructions, pamphlets,
or other written material from your doctor or pharmacy? [HLTHLIT: Health Literacy]
__ Never
__ Rarely
__ Sometimes
__ Often
__ Always
52. Are you currently taking one or more prescription drugs? [RXUSE: Prescription Use]
__ No
__ Yes

17

FDA DTC Survey
Rev: 06/13/16

53. In the last three months, about how many different prescription drugs have you used (for
women: including birth control pills)? [RXUSENUM: Prescription Use: Amount]
[ONLINE SURVEY, PRE-PROGRAM EXTRA TEXT FOR WOMEN BASED ON
RESPONSE TO SEX IN Q2]
______
54. Has a doctor or other healthcare provider ever said you have high cholesterol? [CHOL:
High Cholesterol Status]
__ Yes
__ No
__ Not sure
55. Are you now covered by any form of health insurance or health plan? This would include
any private insurance plan through your employer or a plan that you purchased yourself,
as well as a government program like Medicare or Medicaid. [INSURE: Insurance]
__ Yes
__ No
56. Does your current health insurance plan help pay for prescription drugs? [INSURERX:
Insurance Rx]
__ Yes
__ No
__ No health insurance
Finally, here are a few questions about you.
57. Do you speak a language other than English at home? [LANG: Language]
__ Yes
__ No

58. What is your marital status? [MARITAL: Marital Status]
__ Now married
__ Widowed
__ Divorced
__ Separated
__ Never married

18

FDA DTC Survey
Rev: 06/13/16

59. What is the highest level of school you have completed or the highest degree you have
received? (Please select one.) [EDUC: Education]
__ Less than high school
__ High school graduate--high school diploma or the equivalent (for example, GED)
__ Some college but not degree
__ Associate degree in college
__ Bachelor's degree (for example, BA, AB, BS)
__ Advanced or post-graduate degree (for example, Master's degree, MD, DDS, JD, PhD,
EdD)
60. Are you Hispanic or Latino? [HISPANIC: Ethnicity]
__ Yes
__ No
61. What is your race? You may select one or more races. [Race]
__ American Indian or Alaska Native [RACE1]
__ Asian [RACE2]
__ Black or African American [RACE3]
__ Native Hawaiian or other Pacific Islander [RACE4]
__ White [RACE5]
__ Some other race [RACE6]
62. Thinking about members of your family living in this household, what is your combined
annual income, meaning the total pre-tax income from all sources earned in the last year?
[INCOME: Income]
__ $0 to $14,999
__ $15,000 to $24,999
__ $25,000 to $34,999
__ $35,000 to $49,999
__ $50,000 to $74,999
__ $75,000 to $99,999
__ $100,000 to $199,999
__ $200,000 or more

19

FDA DTC Survey
Rev: 06/13/16

[PILOT ONLY] On a scale of 1-5, where 1 is completely negative and 5 is completely positive,
how would you rate your experience of taking part in this survey? [DEBRIEF1]
1
Completely
negative

2

3

4

5
Completely
positive

[PILOT ONLY] Please tell us the main reasons for your rating score? [DEBRIEF2]
[ENTER VERBATIM RESPONSE]

[CLOSE] Thank you for taking part in this important survey. Your help is very much
appreciated. You may close your browser window at this time.

20