First Name
*
Last Name
*
Email
*
Phone
________________________
How long have you been receiving compounded (customized) medications from Scott’s Pharmacy?
1 year
2- 5 years
5 – 10 years
Over 10 years
How many compounded (customized) medications do your receive from Scott’s Pharmacy
1
2
3
4
5 or more
How would you rate Scott’s Pharmacy’s knowledge of compounded (customized) prescriptions?
Very knowledgeable
Somewhat knowledgeable
Not very knowledgeable
Doesn’t have a clue
How often are your compounded (customized) prescriptions ready for pick up on time?
All the time
Most of the time
Half and half
Never on time
How likely are you to recommend Scott’s Pharmacy Compounding Services to people you know?
Very likely
Somewhat likely
No recommendation
Would likely recommend against.