Quick New Member QUESTIONNAIRE

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Please confirm your BEST email that you will READ!*

What is your cell phone (for texting)*

What is your #1 reason for joining?*

What is your biggest concern about joining?*

What does success look like for you? Be specific...*

Who referred you to us? You can enter a person or company name.*

Most of our members come through referrals and we have a generous referral program and want to ensure we give credit where it's due.

Do you have any employees we should contact to give access to the membership? If yes, please put their name and email information.*

Please select all that apply for your pharmacy(ies).*

Retail

LTC

Non-sterile Compounding

Sterile Compounding

New Pharmacy

I am the Owner

I am a Pharmacist

I am a Tech

I am a Manager

I am Other Staff

Revenue is less than $1.5MM

Revenue is between $1.5-3.5MM

Revenue is between $3.5-6MM

Revenue is greater than $6MM

I have 1 location

I have multiple locations

Do you have any urgent or emergency issues we need to address ASAP with you? If YES, please put details below.

Comments

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