JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Patient Survey
Sign in to Google
to save your progress.
Learn more
What product line or strains would you like to see us expand upon?
More concentrates
More edible foods
More Indica strains
More Sativa strains
Current products are adequate
Other:
Clear selection
How do you feel about our current hours of operation?
Our hours of operation are 10:00AM - 8:00PM Mon-Sat, 12:00PM - 4:19PM Sundays
Convenient
Somewhat convenient
Inconvenient
Not at all convenient
Clear selection
Assuming you have visited another dispensary, how do our donation requests compare?
Om of Medicine is more expensive than others
Om of Medicine is about the same as others
Om of Medicine is less expensive than others
Clear selection
How would you compare the quality of our medication?
Om of Medicine is more effective than others
Om of Medicine is as effective as others
Om of Medicine is less effective than others
Clear selection
Assuming you recertified, did you use the same doctor for your most recent recommendation?
Yes
No
Clear selection
Would you ever use a delivery service if we made it available?
Yes
No
Clear selection
If Om of Medicine were to organize group volunteering in the Ann Arbor community, would you participate?
Yes
No
Dependent on days/times
Clear selection
How would you rate your overall experience with Om of Medicine?
Poor
1
2
3
4
5
6
7
8
9
10
Excellent
Clear selection
Give us your thoughts that can help us better improve your experience with Om of Medicine
Your answer
Assuming you have attended a seminar, how would you rate our seminars?
Not Informative
1
2
3
4
5
6
7
8
9
10
Very Informative
Clear selection
What types of events/seminars would you like to attend at Om of Medicine?
Your answer
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report