Premier Pharmacy Patient Satisfaction Survey
Call 844.245.2233 or simply fill out the form below
Email address *
Patient Name *
First & Last Name
Your answer
What state do you live in?
Doctor's Name
Your answer
Do you remember the name of the Premier Pharmacy staff member that helped you?
Your answer
What prompted you to choose Premier Pharmacy?
Your answer
When was the last time you had a prescription filled at Premier Pharmacy? *
How would you describe your condition BEFORE using your prescription? *
How would you describe your condition AFTER using your prescription? *
Please rate each statement below *
Excellent
Good
Fair
Poor
N/A
Overall Service
Courtesy
Communications
Thoroughness
Dependability
Reliability
Product Knowledge
Product Availability
Do you have any additional comments or questions?
Your answer
Would you recommend Premier Pharmacy to a friend *
Premier Pharmacy has your permission to:
Yes
No
Share my response to this survey with my Doctor's office
Display this survey in the lobby of their office
Type the characters you see above (case sensitive) *
Your answer
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