| Rate your experience with each (required fields marked with *) |
| How satisfied were you with the education provided about your medication? * |
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| How satisfied were you with the education and counseling provided about your health condition or problem? * |
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| How satisfied were you with our pharmacy staff's ability to quickly answer questions and/or resolve any issues? * |
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| How satisfied were you with the condition and accuracy of your filled prescription? * |
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| How satisfied were you with the speed at which your medication was delivered? * |
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| How often were you able to talk to our pharmacy staff about your health or your filled prescription? |
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| Do you want to provide any additional comments or suggestions? |
(Please do not enter identifying information or diagnosis information here.)
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