Pharmacy Grievances Form
This grievance form is for feedback or concerns related to our pharmacy service or prescription delivery only.
If you are having trouble signing up, or need assistance with your account, please text in to "44872," or call us at (772)217-4557 to reach customer service. Thank you for bringing your concern to our attention as it will assist us in improving the quality of our pharmacy services!
Date of Birth
Description of the pharmacy concern/complaint (include prescription number and date, if possible).
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of The Pill Club.