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Please take a moment to fill out this brief survey about your most recent experience using the InstyMeds Prescription Medication Dispenser.

We value your input!

* 1. What health care facility did you use the InstyMeds dispenser at?

* 2. Please provide the following information about yourself

  Gender
Your gender:

* 3. Please provide the following information about yourself

  Age
Your age:

* 4. Please provide the following information about yourself

  Number
Number of children:

* 5. Please provide the following information about yourself

  Number
Number of children with you at the time of using InstyMeds:

* 6. Did you use InstyMeds to get a medication for yourself or a family member?

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