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| What pharmacy do you use? |
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| Does your family also use this pharmacy? |
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| How long has it been your pharmacy? |
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Do they provide good customer service? Rate on a scale of 1-10. Check Yes or No and indicate service rating.
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| Do you purchase other items when filling prescriptions? |
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| Does your pharmacy offer delivery or any other special service? |
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| Is the pharmacy you use close to your school, work, or home? |
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| Do they ask if you require any assistance from the Pharmacist at every visit? |
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