Testimonials Form

Your Name Your Name First Last
Patient's Name (If different than above) Patient's Name (If different than above) First Last
Email
Phone
Pharmacy Staff
The staff took time to listen to my questions and answered them clearly

The staff took time to listen to my questions and answered them clearly Agree Neutral Disagree
The pharmacy staff is knowledgeable and caring

The pharmacy staff is knowledgeable and caring Agree Neutral Disagree
Pharmacy Services
I received my medications in a timely manner

I received my medications in a timely manner Agree Neutral Disagree
It was easy to contact the pharmacy staff

It was easy to contact the pharmacy staff Agree Neutral Disagree
Free shipping is important to me

Free shipping is important to me Agree Neutral Disagree
Pharmacy Rating
Overall, I had a positive experience with your pharmacy

Overall, I had a positive experience with your pharmacy Agree Neutral Disagree
I will refer my friends and family to your pharmacy

I will refer my friends and family to your pharmacy Agree Neutral Disagree
Share your Testimonial (your problem, failed therapies - if any, how we helped to solve your problem)
Do you authorize us to use this testimonial - without mentioning your name, initials or location – in our marketing materials and on our website?

Do you authorize us to use this testimonial - without mentioning your name, initials or location – in our marketing materials and on our website?
Yes No