Hearing from our customers is important to us! Please take a moment and complete this survey using our online form. Alternatively, you may also print a survey form to complete and return to us by clicking here.  We appreciate your input as we strive to make your experience with us the best it can be! Using this key, please rate the quality of services listed below.

Unsatisfactory Substandard Satisfactory Very Good Excellent
1 2 3 4 5

[contactform email=”info@gaughns.com” subject=”Patient Satisfaction Survey” success=”Thank you for your feedback!”]
[radio label=”The medication/products(s) were provided in a timely manner.” value=”1,2,3,4,5″]
[radio label=”Your medical history and drug interaction was reviewed by the pharmacist.” value=”1,2,3,4,5″]
[radio label=”The pharmacist and staff answered your questions in easy to understand terms.” value=”1,2,3,4,5″]
[radio label=”Your insurance carrier/Medicare/Medicaid was billed promptly.” value=”1,2,3,4,5″]
[radio label=”You would likely refer friends and family to our pharmacy.” value=”1,2,3,4,5″]
[radio label=”What is your opinion of our overall performance?” value=”1,2,3,4,5″]
[textarea label=”If you would like us to contact you, regarding services you received from us, please comment below and provide your name and telephone number.”]
[name label=”Name (Optional)”]
[email label=”Email Address”]
[textfield label=”Phone Number (Optional)”]
[autoresponder fromName=”Gaughn’s Drug Store” fromEmail=”website@gaughns.com” subject=”Thank you for completing our Patient Satisfaction Survey!” message=””Hello %First Name%, Thank you for completing our Patient Satisfaction Survey. We appreciate and value your feedback. If you have requested we contact you regarding services you received from us, we will respond to your request as soon as possible. If you would like to speak with us immediately, please contact us at (814) 723-2840. Thank you again! Gaughn’s Drug Store”]
[submit value=”Submit”]