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A pilot project of the Canadian Medication Incident Reporting and Prevention System (CMIRPS).

Optional Survey

This website has been created with you, the consumer in mind. Would you please take a few moments to answer these questions that will help us improve this website?

How did you find out about this website?
  • Internet Search (such as Google, Yahoo)
  • A poster
  • A brochure
  • Internet advertising
  • A friend/family member told me about it
  • A Health professional told me about it (such as a pharmacist, nurse, doctor)
  • Through a consumer or patient organization (name)
  • Other (please tell us):
What was the main reason you visited this website?
  • Report a medication incident/error
  • Just browsing
  • Looking for specific information about safe medication use
  • Other (Please tell us):
How likely is it that information found on the SafeMedicationUse site will change your practices with respect to medication:
How would you rate the overall importance of this website, to you personally? Would you say it is:
Overall, how would you rate your satisfaction with this website?
What, if anything, frustrated you about using this website? (multiple answers are welcome)
  • Nothing
  • Hard to find the home page
  • The layout is confusing
  • Difficult to find the medication incident/error reporting form
  • Couldn't understand some of the information provided
  • Other (please explain)
Did you report a medication incident/error using the reporting format on this website?
  • Yes
  • No
How likely are you to recommend this site to friends, family and/or colleagues?
In your opinion, how suitable is the URL name - - for this website?

Please explain what you mean:

What other information or services, if any, would you like to see on this website?
Do you have any suggestions on how to improve this program?
Your Gender?
  • Male
  • Female
Where do you currently reside? City/Town/Village
What is your age range?
What is the highest level of schooling that you have completed?
  • Public elementary (Grade 8)
  • Some High School
  • Graduated High School
  • Vocational/Technical College
  • Some University
  • Graduated University
  • Post Graduate Studies (MBA, MA, PhD)
  • Other (please specify)

Thank you very much! We appreciate you taking the time to provide us with your feedback.

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