Customer Survey
Email
example@example.com
How would you rate your interaction with the staff?
Very Unsatisfied
Unsatisfied
Adequate
Satisfied
Very Satisfied
How would you rate the wait time when picking up your medication?
Very Unsatisfied
Unsatisfied
Adequate
Satisfied
Very Satisfied
Did the pharmacist/staff explain your medication in a way that was clear and understandable?
Yes
No
How satisfied were you with your overall experience?
Very Unsatisfied
Unsatisfied
Adequate
Satisfied
Very Satisfied
One way that this pharmacy could serve me better is by:
Submit
Should be Empty: