Galen Pharmacy Patient Satisfaction Survey
Please rate your experience on a scale of 1-5. 1=Poor 5=Great
Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
During your visit the staff was polite and helpful.
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
During your visit the pharmacy was clean and organized.
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
The staff was knowledgable about my medication(s)
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
The staff seemed truly interested in my health and wellness.
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
For medication deliveries, medications were delivered in a timely manner.
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
Wait times for appointments/medication dispensing.
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
Please rate the overall level of the service you received.
1-Poor
2-Fair
3-Good
4-Very Good
5-Excellent
Questions or Comments:
Submit
Should be Empty: