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* 1. What is your first and last name?

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* 2. What is the highest level of education you have completed?

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* 3. Email address:

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* 4. Do you believe the Walmart policy will negatively impact patient care?

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* 5. Have you experienced a situation in which a pharmacy has denied filling a physician ordered prescription? 

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* 6. If yes, please share an overview of the situation:

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* 7. Any additional comments pertaining to the Walmart prescription policy are welcomed:

Thank you for taking the time to provide this feedback. We will keep you informed of any changes to the policy. 

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