SurveyMonkey Powered Online Survey

TPC Online Web Demo Registration

Please complete this form to receive access to the short online demonstration of The Pharmacy Connection software.

Once the registration is received, you will receive access to view the demo within 1-2 business days. If you have any questions, please contact TPC Staff at tpc@vhcf.org or 804-828-5803.

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1. Contact Information

Name:

Organization:

State:

Email Address:

Phone Number w/Area Code:

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2. Is your organization Non-Profit or For-Profit?

Non-Profit

For-Profit

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3. What best describes your type of organization?

Area Agency on Aging

Community Services Board

Federally Qualified Health Center

Free Clinic

Hospital

Local Health Department

Oncology Practice

Physician Practice

Social Services

Other

Other (please specify)

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4. How did you hear about The Pharmacy Connection software?

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5. Comments or Questions:

100% of survey complete.

Question Title

1. Contact Information

Question Title

2. Is your organization Non-Profit or For-Profit?

Question Title

3. What best describes your type of organization?

Question Title

4. How did you hear about ﻿The Pharmacy Connection ﻿software?

Question Title

5. Comments or Questions:

4. How did you hear about The Pharmacy Connection software?