Client Satisfaction Survey Form (#13) Dear Yurek Customer, We value your opinion and are striving to improve our services to you. Please take a moment to complete the brief survey below, so we may better understand how to meet your needs. Peter Yurek You are filling out the survey, based on your recent experience at? Yurek Pharmacy & Home Healthcare, St. Thomas Yurek Pharmacy & Home Healthcare, London Yurek Specialties, Southern Ontario (Home Infusion & Medical Supplies) Yurek Mobility Yurek Online Shopping Just Between FriendsPlease indicate the contact/department you are providing feedback. Wig Consultation Mastectomy Fittings Fashion Clothing FittingsPlease indicate the contact/department you are providing feedback. Online experience DeliveryPlease indicate the contact/department you are providing feedback. Home Healthcare Delivery PharmacyPlease indicate the contact/department you are providing feedback. Sales Repair servicePlease indicate the contact/department you are providing feedback. Medical Supplies Delivery Pharmacy Customer Service RepresentativeAre you a new customer at Yurek? Yes NoHow long have you been a customer with us?What factor(s) influences you when choosing a pharmacy, home healthcare or mobility provider? Efficient and prompt service Location Professionalism of staff (attitude, understanding) Quality of staff knowledge Cost Brand/reptuationSelect the stars to rate each of the aspects below:5=Highest   4=Above Average        3=Average    2= Below Average       1=UnacceptableCourteousness/helpfulness of staffTimeliness of receiving your products or serviceThe information communicated to youYour overall satisfactionWe are interested in serving you and the healthcare needs of your family. We appreciate any other helpful feedback to help us make our services valuable to you:Responder InformationPlease provide a valid email address to be entered into a draw for a $100.00 gift certificate, along with your full name.First NameLast NameEmailSubmit Survey
