Customer Satisfaction Survey
Your satisfaction is very important to us. Please help us in our mission to provide the best service to you by filling out this short survey. We value your feedback!

Survey Rating: Please rate your satisfaction for each of the following questions on a scale of 1-5
1: Very Unsatisfied, 2. Unsatisfied, 3. Adequate, 4. Satisfied, 5. Very Satisfied

You may skip the questions that don't apply to you.

The professional appearance of the pharmacy. E.g. neat, clean, organized.
Very unsatisfied
Very satisfied
The professionalism of the pharmacist(s). E.g. respectful, caring, courteous.
Very unsatisfied
Very satisfied
The professionalism of the pharmacy technicians and other staff members. E.g. respectful, courteous, caring
Very unsatisfied
Very satisfied
The quality of the products/medications I received.
Very unsatisfied
Very satisfied
The timeliness in getting a prescription filled.
Very unsatisfied
Very satisfied
The hours of operation.
Very unsatisfied
Very satisfied
The ability of the pharmacist to answer my questions.
Very unsatisfied
Very satisfied
The pharmacist’s efforts to help me improve my health/stay healthy.
Very unsatisfied
Very satisfied
My overall satisfaction with the services provided to me.
Very unsatisfied
Very satisfied
If you marked "unsatisfied" (2) or "very unsatisfied" (1) for any of the above questions, please tell us why below. If you're unsatisfied, we would like to make it right. Please provide your email/phone number so we can get in touch with you.
Your answer
Please feel free to write any additional comments you may have.
Your answer
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This form was created inside of Clark Professional Pharmacy.