Clinical Consensus Survey Form
Clinical Consensus Survey Form
Your Clinical Role or Specialty
*
Please Select
Physician
Nurse
Pharmacist
Therapist
Researcher
Other
Years of Clinical Experience
*
Please Select
Less than 5 years
5–10 years
11–20 years
More than 20 years
Please indicate your level of agreement with the following clinical statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The proposed clinical guideline is evidence-based.
1
2
3
4
5
The guideline is feasible to implement in practice.
6
7
8
9
10
The guideline addresses relevant clinical outcomes.
11
12
13
14
15
The guideline is clear and unambiguous.
16
17
18
19
20
How would you rate the clarity of the clinical guideline?
*
1
2
3
4
5
How likely are you to recommend this guideline to peers?
*
Not Likely
1
2
3
4
5
6
7
8
9
Extremely Likely
10
1 is Not Likely, 10 is Extremely Likely
What barriers do you foresee in implementing this guideline?
Which aspects of the guideline require further clarification?
Overall, how satisfied are you with the consensus process?
*
1
2
3
4
5
Additional comments or suggestions
Submit
Should be Empty: