Pharmacy Customer Service Feedback

Pharmacy Customer Service Feedback — Form Fields

This feedback template includes 11 fields. Evaluate pharmacist helpfulness, prescription wait times, and overall pharmacy experience. Free to customize and use on ZenBuild.

• Your Name (text, optional)
• Email (email, optional)
• Pharmacy Location (dropdown selection, required) — options: Downtown, Northside, Eastside, Westside, Online/Mail-order
• Visit Purpose (dropdown selection, required) — options: New prescription, Refill, Consultation, Immunization, OTC purchase, Other
• Wait Time for Prescription (multiple choice, required) — options: Under 10 minutes, 10-20 minutes, 20-30 minutes, Over 30 minutes
• Pharmacist Knowledge (rating, required)
• Staff Friendliness (rating, required)
• Prescription Accuracy (rating, required)
• Overall Experience (rating, required)
• Would you transfer prescriptions here permanently? (multiple choice, required) — options: Yes, No, Already a regular customer
• Comments or concerns (long text, optional)