Customer Survey
 
FREE 2 LITER COKE FOR FILLING OUT OUR SURVEY
Please print out survey and return it to our Pharmacy to receive your free 2 liter coke. 1 FREE per household.

  1. Do you shop Newhard Pharmacy?    Yes      No

  2. Do you shop Online?    Yes      No

  3. Do you get your prescriptions here?    Yes      No

  4. If not why?  

  5. Do you buy your health and beauty aids at Newhard Pharmacy?    Yes      No

  6. If not why?  
    where?  

  7. Do you plan to buy at Newhard Pharmacy online, from our website?    Yes      No

  8. If not why?  

  9. Did you know, we deliver local at no charge?    Yes      No

Name: 
Address: 
City:       State:      Zip: 
Age:       Phone: 
E-Mail Address: 


             

 





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