The Montana Pain and Symptom Management Task Force (MPSMTF)
Feedback Form

In an effort to assist the Task Force with quality improvement, please review all questions and fill in any comments you have. Be as specific as possible. For follow up or to get involved, be sure to fill out the contact information at the end.

1. Do you have any general comments or suggestions about the White Paper?

2. What do you like best about the White Paper?

3. Is there anything in the whitepaper that would be potentially counterproductive to its implementation and usefulness?

4. In your opinion, what is missing from the White Paper?

5. How do you see the White Paper benefiting either you as an individual, your practice and patients, your community, the State of Montana?

6. Is there a part of the White Paper you and/or your organization would like to work on implementing? If so, list below by recommendation.

7. What resources do you know of that could be utilized for improving pain management in Montana?

Become Involved! I would like to be kept updated about the Montana Pain Initiative.

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May we contact you by telephone to follow up on your comments and suggestions?
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Thank you for the feedback and comments.

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The Montana Pain and Symptom Management Task Force (MPSMTF) Feedback Form

Revised: July 23, 2007

The Montana Pain and Symptom Management Task Force (MPSMTF)
Feedback Form