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* 1. Are you a Friendlies member?

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* 2. When did you last shop with Friendlies?

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* 3. My age range is

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* 4. Typically, how often do you purchase from a pharmacy?

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* 5. Have you ever shopped online?

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* 6. Where do you find information about Friendlies? (please select all that apply)

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* 8. My family status is

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* 9. What would you like to see more of? (please select all that apply)

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* 10. Would you like to shop online with Friendlies?

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* 11. When I visit a pharmacy, I purchase for... (please select all that apply)

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* 12. I want from my community pharmacy... (please select all that apply)

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* 13. The Friendlies Chemist can be more involved in the community by...

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* 14. The Friendlies Chemist can improve by...

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* 15. Your contact information (optional)

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