CPS PharmaChat Feedback Form
Please use this form to report any software incidents or problems you encounter.
Date and Time of Incident
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Name
First Name
Last Name
Email
example@example.com
Role
To understand the perspective or background of the responder.
Page or Feature Reviewed
Specify which part of the chatbot (e.g., specific question or functionality) the feedback pertains to.
Type of Feedback
Please Select
Bug Report
Suggestion
Compliment
Other
Categorize the feedback for better sorting and prioritization.
Severity of Issue
Please Select
Low
Medium
High
N/A
To gauge the urgency of any problems reported.
Detailed Description of Feedback
To allow for a detailed description of the experience or issue encountered. Please include your question and the answer if possible.
Error Message (if any)
Screenshot or File (if applicable)
Browse Files
Drag and drop files here
Choose a file
To provide visual data or further detail about the issue.
Cancel
of
Suggestions for Improvement
To collect specific ideas or actions for improving the chatbot.
Submit
Should be Empty: