Use the Online Medicine Order Form to collect customers' personal details as well as their medical histories like allergies, medical conditions, current medications, and more. Click on the ‘Use this template’ and get started by collecting the details.
Are you having an illness and want to order your medicine online? Use this template to ease the process for your customers and make it seamless for them to order medicines.
Pharmacies and medical stores can use this Online Medicine Order Form to collect their customer's information and serve them better. The form comes with ten simple questions asking customers about different things. They can choose from the options and send out the form for their medicine order.
Get started right away with a free trial.
Use Zonka Feedback to create healthcare surveys to engage with your customers. Once you have created your survey, the distribution is quite easy, as you can reach your customers via Tablets, SMS, Email, Widgets and more.
You can customize the survey and make it stylish as you want. Choose the background image and add questions, choosing from different question types such as multiple choice, rating, opinion scales, and more.
10
11
2 mins
The following questions are included in this Online Medicine Order Form.
Sign Up or Sign In on Zonka Feedback for free and try this Online Medicine Order Form to simplify online medicine ordering for patients and ease the understanding of customers and their symptoms for pharmacies.
1. How do you create an online medicine order form?
It’s easy to create a template with Zonka Feedback, you can choose the survey from our and dashboard and start using it straight away. You can also customize the questions in the survey template with a dropdown, textbox, and add logic as well. Then, you can publish the form and share it with the customers, so they can fill their orders online in a secure place.
2. What is an online medicine order form?
An online medicine order form is used by pharmacies or medical suppliers for collecting information about the customers such as their name, email id, age, any medical conditions they have.
3. Where can I use this Online Medicine Order Form?
You can use a QR code at your touchpoint. Another method is to send an email or SMS survey to the customer once the service is completed. If you don't have access to the internet, you can conduct offline surveys using kiosks, mobile devices, or tablets.
Web Surveys%201.svg)
Email Surveys%201.svg)
SMS Surveys
WhatsApp Surveys%201.svg)
In-App Feedback%201%20(1).svg)
In-Product Feedback%201.svg)
Offline Surveys.svg)
In-App Mobile SDK
.svg)
%201%20(1).svg)
.svg)
.svg)
Salesforce 
HubSpot
ActiveCampaign
Pipedrive
Mailchimp
Zendesk 
Intercom
Freshdesk
HelpScout 
Front
Jira
Slack 
MS Teams
Webex
Zoom
Google Sheets 
Zapier 
Integrately
Make 
Webhooks 
Developer APIs
