* 1. Please select one of the following:

* 2. Which services did you have rendered:

* 3. How did you hear about Gastro Health Specialty Pharmacy:

* 4. Thinking of your last visit to Gastro Health Specialty Pharmacy, how would you rate your level of satisfaction to the following:

  Very Satisfied Satisfied Dissatisfied Very Dissatisfied N/A
Knowledge and helpfulness of the pharmacy staff
Courtesy and friendliness of the pharmacy staff
Waiting time for your prescription
Your overall satisfaction with your experience at Gastro Health Specialty Pharmacy

* 5. Thinking of your last visit to Gastro Health Specialty Pharmacy, how would you rate your level of satisfaction to the following:

  Very Satisfied Satisfied Dissatisfied Very Dissatisfied N/A
Patient educational materials you may have received
Pharmacist consultation
Comfort, cleanliness and amenities of the pharmacy

* 6. The service/care provided was valuable to improving my health.

* 7. Would you recommend Gastro Health Specialty Pharmacy to family or friends?

* 8. Would you return to Gastro Health Specialty Pharmacy for future prescription fills?

* 9. We would like to hear your feedback, please provide us with any comments you wish to convey to our team.

* 10. Please provide us with any suggestions or recommendations for improvement.

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