1. Which location did you visit or contact?

2. Is this the first time you have used this pharmacy?

3. On your most recent visit, were your acknowledge and greeted immediately?

4. Was your prescription ready when promised?

5. Did the staff notify you if there was a delay in filling your prescription?

6. If the medication was not in stock and you needed immediate care, did the pharmacy staff offer to locate it at another pharmacy?

7. Did the pharmacy staff offer to order any item not in stock?

8. Did the pharmacist talk to you about the prescriptions picked up?

9. Was the pharmacist helpful?

10. Were you greeted promptly on the phone?

11. If you were on hold for more than 30-60 seconds, did the staff acknowledge you?

12. Would you recommend Kentwood Pharmacy?

13. I felt welcomed by the pharmacy staff.

14. The appearance of the pharmacy met my expectations.

15. The pharmacy staff met my expectations for professionalism.

16. The telephone etiquette used by the pharmacy staff met my expectations.

17. Was your delivery made in a timely fashion?

18. How would you rate your overall pharmacy experience?

19. Please tell us how we helped you today.

20. Please tell us how we can improve your next visit to Kentwood Pharmacy.

21. Additional comments or concerns:

22. Would you like to be contacted to further discuss your comments and concerns?

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Thank you for your time!