Pharmacy Services Customer Feedback


Feedback

*1 Date

Format: mm-dd-yyyy

*2 Pharmacy Location

Choose one of the following answers

*3 How long did you wait to be served at the pharmacy?

Choose one of the following answers

*4 How satisfied are you with the amount of time it took to get the service?

Choose one of the following answers

*5 Are you satisfied with the level of professionalism of the staff?

Choose one of the following answers

*6 Upon receipt of prescription, were you counseled / told how to take your medication?

Choose one of the following answers

*7 How satisfied are you with the overall quality of our service delivery?

Choose one of the following answers

8 Please write any other comments: