Comments/Feedback
Was our service:
*
Excellent
Good
Satisfactory
Unsatisfactory
What did you appreciate about our service?
How can we improve to better meet your needs?
Comments about your compounded prescription(s)
Please enter the Rx#, then answer any questions that apply to that prescription.
Rx#
Did you have any problems with administration?
No
Yes
If yes, please explain.
Did we explain how to use your medication clearly?
No
Yes
If no, please explain.
Do you like the consistency and/or flavor?
Do you have any questions about your therapy?
Rx#
Did you have any problems with administration?
No
Yes
If yes, please explain.
Did we explain how to use your medication clearly?
No
Yes
If no, please explain.
Do you like the consistency and/or flavor?
Do you have any questions about your therapy?
How has a customized medication improved your quality of life?
Enter the message as it's shown
*
Submit
Should be Empty: