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Customer Satisfaction Survey Questionnaire Form
Please let us know about your experience with our products and service
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Step 1
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Step 2
*
Which Stonegate Pharmacy location did you visit:
William Cannon
Southwest Medical Village
Stonegate Pharmacy on Broadway
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Would you recommend it to your friends and colleagues:
Yes
No
N/A
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*
How satisfied are you with our company overall:
Very Satisfied
Satisfied
Undecided
Unsatisfied
Very Unsatisfied
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Please evaluate the pharmacy staff:
Don’t Know
Poor
Fair
Good
Great
Service Quality
Responsiveness
Kindness and Helpfulness
Friendliness/politeness
Answers the phone/returns phone calls
Fills your prescriptions on time
Maintains your privacy
Answers your questions
Provides advice on medications and healthcare services
Counsels you on your new prescription medications
Overall customer service
Likelihood of you referring us to a friend or family member
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What do you like best about our pharmacy:
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What do you like least about our pharmacy:
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Suggestions for improvement:
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Full Name:
First Name
Last Name
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Email Id:
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Please enter valid email address
Mobile No:
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Invalid phone number.
The value must be less than or equal to 20
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