Psychoactive Medication Survey

This 13 question survey asks you to describe your experience of taking prescribed psychoactive drugs. The survey should not take more than 5 minutes to complete Please answer as openly as possible - your responses are guaranteed to be confidential. Your information will not be released and no personally identifiable information is collected.

If you would like to receive notification of the results once the survey period is complete, then please provide your e-mail address. Otherwise leave it blank. Once again, your e-mail address will not be used for any other purpose and will be confidential.
Your E-mail address    
1
Which country are you a citizen of?
2
What is your household's monthly income?
3
When were you taking prescribed psychiatric medication?
4
For how long did you take the medication? If you are still taking it, how long have you been doing so?
5
Who prescribed the medication to you?
6
Place a tick next to each category of medication you took or are still taking
7
I know the trade name of the drug(s) I took or am currently taking (Eg Prozac, Haloperodol)
8
I know the possible side effects of the medication(s) I took or am currently taking.
9
To what extent do you believe that these medications helped or are helping you.
10
I experience or have experienced side effects of the medication I'm taking
11
If you answered true the last question, please tick the statement that is most true of your experience of them
12
If you have experienced side effects, please use the box to desribe the most prominent ones.
13
Have you made use of counselling or psychotherapeutic services in addition to the medication.
Thank you for participating in this survey. Come back to www.psychotherapy.co.za over the next months and view the results and report. Once you click the submit button, your answers will be displayed to you. For your records you may print that page or just close the browser windon.
 
   



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