Phone: 706.721.0131 OR 1.800.736.2273 ext.0131 Fax: 706.721.0754

Survey for Health Professionals Medication Access Program

Please read each of the statements carefully, and circle the number below the statement that corresponds to your opinion. Thank you very much for your time and effort in completing this survey. Please return the completed survey to: MAP, 1120 15th Street, Room FI-1063, Augusta University Medical Center, Augusta, GA 30912; 706-721-0131; FAX: 706-721-0754

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