Customer Service Satisfaction Survey
Please rate your experience at our pharmacy on a scale of 1 to 5.
DURING YOUR VISIT, THE STAFF AT THE PHARMACY WAS POLITE AND HELPFUL.
Please Select
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
DURING YOUR VISIT, THE PHARMACY WAS CLEAN AND ORGANIZED.
Please Select
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
THE STAFF WAS KNOWLEDGABLE ABOUT MY MEDICATIONS.
Please Select
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
THE STAFF SEEMED TRULY INTERESTED IN MY HEALTH AND WELLNESS.
Please Select
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
PLEASE RATE THE OVERALL LEVEL OF SERVICE YOU RECEIVED.
Please Select
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
DATE OF YOUR VISIT
-
Month
-
Day
Year
COMPARED TO COMPETITORS, OUR CUSTOMER SERVICE IS
Please Select
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
How familiar are you with our services?
I use your services frequently
I only used your services one time
I sometimes use your services
I never used your services before
I rarely use your services
How likely are you to continue to use our services?
Very likely
Likely
Not likely
Not likely at all
I don't know
Other
Do you want to add or suggest something?
Name (Optional)
First Name
Last Name
Email (Optional)
example@example.com
*
Submit
Should be Empty: