Rx Feedback Form

Comments/Feedback

	We appreciate your comments and feedback about our service and your compounded prescriptions. Your comments are held in strict confidence.
Was our service (*)	ExcellentGoodSatisfactoryUnsatisfactory Invalid Input
Was there anything we can improve?	Invalid Input
Can we provide any additional service to better meet your needs?	Invalid Input
	Comments about your compounded prescriptions. Please enter the Rx#, then answer any questions that apply to that prescription.
Rx # (*)	Invalid Input
Did you have any problems administering you medication? (*)	YesNo Invalid Input
If yes, please explain	Invalid Input
Did we explain how to use your medication clearly? (*)	YesNo Invalid Input
If No, please explain	Invalid Input
Do you like the consistency and/or flavor? (*)	YesNo Invalid Input
If No, please explain	Invalid Input
Do you have any questions about your therapy?	Invalid Input
Your email address (*)	Invalid Input
	You can call us at 828-324-4115
	Please type the letters that you see. Hit refresh if letters are not clear. This helps prevent Spam abuse of this form, Thank you.
Spam filter	Refresh Invalid Input
Thank you for your feedback