Patient Survey

All Questions are Mandatory!

  1. 1.
    Did your physician or pharmacist inform you of Mylan Pharmaceuticals ULC’s Clarus® CLEARTM Program Website (
  2. 2.
    Did your physician discuss the effective methods of birth control before beginning therapy?
  3. 3.
    Did you complete an informed consent form with your Clarus® prescriber?
  4. 4.
    Were you provided with or did you download the Clarus® educational materials?
  5. 5.
    You must have ___ negative pregnancy tests before starting Clarus® therapy.
  6. 6.
    How many methods of birth control should you use while on Clarus® therapy?
  7. 7.
    You must have a pregnancy test performed in an approved laboratory ___ while taking Clarus®.
  8. 8.
    You must have a pregnancy test performed in an approved laboratory one month after stopping treatment with Clarus®.
  9. 9.
    If you choose to continue treatment with Clarus® you must obtain a new prescription each month.
  10. 10.
    Pregnancy testing, issuing a prescription and dispensing of Clarus® should occur on the same day.
  11. 11.
    If you become pregnant while using Clarus® you must notify your physician immediately.
  12. 12.
    If you have unprotected sex while taking Clarus® notify your doctor immediately and discuss emergency contraception such as Plan B or Contingency ONE.
  13. 13.
    Which of the following is not an acceptable form of effective birth control?
  14. 14.
    Which of the following is a serious side effect of Clarus®?