Pharmacy Service Satisfaction Survey

Survey

Please let us know about your experience with our products and service.
Would you recommend us to your friends and colleagues?

YesNo
How satisfied are you with our pharmacy overall?*

Very SatisfiedSatisfiedUndecidedUnsatisfiedVery Unsatisfied

Please evaluate the pharmacy staff:*

	Don’t Know	Poor	Fair	Good	Great
Service Quality
Responsiveness
Kindness and Helpfulness
Friendliness/politeness
Answers the phone/returns phone calls
Fills your prescriptions on time
Maintains your privacy
Answers your questions
Provides advice on medications and healthcare services
Counsels you on your new prescription medications
Overall customer service
Likelihood of you referring us to a friend or family member

What do you like best about our pharmacy?
What do you like least about our pharmacy?
Suggestions for improvement?
Please leave your email address so we can seek further clarification or additional feedback regarding your responses.
Full Name

First NameLast Name
E-mail Address
Thank you for completing our survey.
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