Interactive Customer Evaluation
 
OMB 0704-0420, expires 31 OCT 2017
RCS DD-DA&M(AR)2124, expires 31 OCT 2017

GLWACH Pharmacy (All locations) Comment Card

GLWACH Pharmacy (All locations)
Comment Card

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General Leonard Wood Army Community Hospital Pharmacy division makes every effort to provide accurate and efficient service. We are interested in your views and suggestions concerning pharmacy service. Please tell us about your pharmacy experience and how we can improve. Thank you!

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Were you satisfied with your overall experience?

  
  
  

Date of your visit

Time of your visit

Please specify which Pharmacy (location) visited

  
  
  
  

Facility Appearance

  
  
  
  
  
  

Employee/Staff Attitude

  
  
  
  
  
  

Timeliness of Service

  
  
  
  
  
  

Hours of Service

  
  
  
  
  
  

Did the product or service meet your needs?

  
  
  

Courtesy and helpfulness of the staff during this visit

  
  
  
  
  
  

Coordination among all the people who cared for you during your visit

  
  
  
  
  
  

The comfort of the facility you visited

  
  
  
  
  
  

The convenience of the facility you visited

  
  
  
  
  
  

Overall, how would you rate your visit to the Pharmacy

  
  
  
  
  
  

  (optional) 0/4000


 


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Privacy Advisory: Unless you provide your name, phone, email address or otherwise identify yourself in the text comments on the comment card, all submitted information and comments will remain anonymous. No attempt to identify you or your organization will be made unless the comment card submission or set of submissions reflects a credible or potential threat, or reflects a misuse or abuse of the system, or is related to a law enforcement investigation. If you have a complaint and do not provide a phone number or email address, there will be no way of following up with you directly regarding the complaint. However, all comments and complaints will be examined whether or not you supply contact information. Your comment card submission, including the text comments, may be reviewed by multiple people associated to the service provided. This may, in some cases, include higher levels in the service provider's chain of command. By providing comment information in the text comment box, you are acknowledging that the information provided may be reviewed throughout the organization to which the comment was submitted, and, possibly at higher organization levels within the ICE system.



 





"Thank you for taking the time to complete this comment card. Your opinions are very important to us."