Problem Resolution Reporting Program

Please complete this form to report problems you may be experiencing in having prescriptions filled at Walgreens pharmacies.
1. Date:
Today's Date:
2. Contact Information
3. Investigators from Walgreens may find it helpful to discuss the particulars of the incident with you. You may choose whether to keep your identity confidential, or to release it to Walgreens so that they can follow up with you. If you do not agree to release your identity, they will work with the information available from your report. Please indicate your preference below: