Customer satisfaction survey/complaints

    Date of Birth

    Overall, how satisfied are you with our service?

    1 2 3 4 5 6 7 8 9 10
    Dissatisfied Highly Satisfied

    Would you recommend us to others?

    1 2 3 4 5 6 7 8 9 10
    Not Likely Highly Likely

    Please use the text box below to comment on why you chose the above rating.


    Preferred way for the pharmacy to contact you?

    Via EmailVia Phone