Medication Adherence Motivation Survey
Please answer the following questions about your motivation and barriers to taking medication as prescribed.
How motivated are you to take your medication as prescribed?
1
1
2
3
4
Best
5
1 is , 5 is Best
What motivates you to take your medication?
Option 1
Option 2
Option 3
What barriers do you experience that make it difficult to take your medication?
Option 1
Option 2
Option 3
Please describe any other factors affecting your medication adherence.
Submit
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