PHARMACIST DATA FORM

Survey of Various Brain Tumour Drugs

Name of the PHARMACIST -

Address -
Which drug is mostly prescribed?

AFINITOR (EVEROLIMUS)
AFINITOR DISPERZ (EVEROLIMUS)
AVASTIN (BEVACIZUMAB)
BEVACIZUMAB
BICNU (CARMUSTINE)
CARMUSTINE
CARMUSTINE IMPLANT
EVEROLIMUS
GLIADEL WAFER (CARMUSTINE
IMPLANT)
LOMUSTINE
TEMODAR (TEMOZOLOMIDE)
TEMOZOLOMIDE

Reason for Prescribing these drugs

 Less side effects
 Cost
 Patient Compliance
 Frequent Visit of Representation
 Dose Convenience

Pharmacist’s Sign
Thankyou Pharmacist

Survey

Date:
By:
 MARKET SURVEY ON BRAIN
TUMOUR DRUGS

PHARMACIST NAME:

STORE NAME:

ADDRESS OF PHARMACY:

SURVEY DATA
BRAND NAME GENERIC COMPANY PRICE FORM OF NO. OF
NAME (IN ₹) DRUG SELLING
DRUGS
QUESTIONAIRE

Are you selling Brain Tumour drugs:-

Which is the most selling drug:-
Total sale of the most selling drug:-
Average no. of customer buying drug:-
Type of dose mostly used by patients:-
Which product is available at the most reasonable price:-
Is there any side effect of the most selling drug:-