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First Name:   

Last Name:   

Clinic Name:   

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Which of the following compounded medications are typically prescribed at your clinic?

Select all that apply:

Injectable Compounds

  Leuprolide Trigger
  Leuprolide + HCG Trigger (Combination)
  Micro-dose HCG
  Micro-dose Leuprolide
  Progesterone in Ethyl Oleate
  Progesterone in Olive Oil

Suppositories, Capsules, etc.

  Estrogen Suppositories
  Progesterone Suppositories
  Estrogen + Progesterone Suppositories
  Progesterone Micronized Capsules
  Progesterone Lozenges

How has your clinic’s use of Leuprolide Triggers changed over the past 3 years?

  Remained the same

  Please have my local MDR representative contact me with more information about the Leuprolide Trigger Prefilled Syringe.

What proportion of your clinic’s patients are traveling to the U.S. from another country to pursue treatment?

  10 - 20%
  21 - 30%
  31 - 40%
  41 - 50%

How important is it for your patients to utilize a local pharmacy for their IVF medications?

  Not important if next day delivery is available
  Somewhat important
  Very important