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Customer Service Survey

Your Locally Owned Drug and Variety Store

Find a Location

Customer Service Survey

Step 1 of 6

16%

Store Location:
Date of Store Visit:
MM slash DD slash YYYY
Time of Store Visit:

: Hours

Minutes

AM/PM

Was the store clean?
- Yes
- No
Was the quality of the product satisfactory?
- Yes
- No
Were you greeted by an employee?
- Yes
- No

Was the product you desired available?
- Yes
- No
Were sale items clearly marked?
- Yes
- No
Were your purchases checked out quickly?
- Yes
- No

You chose our store because (you may check more than one):
- Convenient Location
- Advertised Items
- Prescription Department
- Friendly Service
- Recommended by a Friend
- Other (describe in Comments section)
Comments or Suggestions:

How many times per month do you shop this store?
- More than 3 times
- Less Than 3 times
- Third Choice
Would you recommend this store to a friend?
- Yes
- No
May we contact you?*
- Yes
- No

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Comments
This field is for validation purposes and should be left unchanged.

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