Satisfaction Survey
Name
First Name
Last Name
Date of Service
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about Hoagland Pharmacy?
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Family / Friend
Physician / Healthcare
Other
Which Hoagland Pharmacy location served you? Please check all that apply:
LTC
Retail
Which Hoagland Pharmacy department(s) did you receive service from? Please check all that apply:
Bookkeeping
Home Medical Equipment
Immunization Services
LTC Pharmacy
Mediset
Compounding
Retail Pharmacy
Specialty
Our phone staff was courteous and polite.
N/A
1
2
3
4
5
Our in store staff was helpful and knowledgeable.
N/A
1
2
3
4
5
While in the store you were assisted in a timely manner.
N/A
1
2
3
4
5
If you had your order delivered, your delivery arrived at your home within the promised time frame.
N/A
1
2
3
4
5
Our delivery staff was respectful of your home and belongings.
N/A
1
2
3
4
5
You are aware of all the products and services we provide.
N/A
1
2
3
4
5
You received enough instruction on the use of your equipment or medication.
N/A
1
2
3
4
5
Your order was complete when you received it.
N/A
1
2
3
4
5
We were able to supply all of the products/ services you need.
N/A
1
2
3
4
5
You would recommend Hoagland Pharmacy to family and friends.
N/A
1
2
3
4
5
Do you have any additional information? Would you like one of our department managers to contact you about your experience?
I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.
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