Patient Survey

This section is about why you visited the pharmacy today
Q1  Why did you visit this pharmacy today?
To collect a prescription for:
Yourself Someone else Both Other     
Note: If you did not collect a prescription, please go to Q3

Q2  If you collected a prescription today, were you able to collect it straight away, did you have to wait in the pharmacy or did you come back later to collect it?
Straight away Waited in pharmacy Come back later
Q3  How satisfied were you with the time it took to provide your prescription and/or any other NHS services you required?
Not at all satisfied Not very satisfied Fairly satisfied Very satisfied
This section is about the pharmacy and the staff who work there more generally, not just for today's visit
Q4  Thinking about any previous visits as well as today's, how would you rate the pharmacy on the following factors? Please tick one box for each aspect of the pharmacy listed below, to show how good or poor you think it is:
ANSWERS: Very Poor Fairly Poor Fairly Good Very Good Don't know
a) The cleanliness of the pharmacy
b) The comfort and convenience of the waiting areas (e.g. seating or standing room)
c) Having in stock the medicines/appliances you need
d) Offering a clear and well organised layout
e) How long you have to wait to be served
f) Having somewhere available where you could speak without being overheard, if you wanted to
Q5  Again, including any previous visits to this pharmacy, how would you rate the pharmacist and the other staff who work there? Please tick one box for each aspect of the service listed below, to show how good or poor you think it is:
ANSWERS: Very poor Fairly poor Fairly good Very good Don't know
a) Being polite and taking the time to listen to what you want
b) Answering any queries you may have)
c) The service you received from the pharmacist
d) The service you received from the other pharmacy staff
e) Providing an efficient service
f) The staff overall
Q6  Thinking about all the times you have used this pharmacy, how well do you think it provides each of the following services?
ANSWERS: Not at all well Not very well Fairly well Very well Never used
a) Providing advice on a current health problem or a longer term health condition
b) Providing general advice on leading a more healthy lifestyle
c) Disposing of medicines you no longer need
d) Providing advice on health services or information available elsewhere
Q7  Have you ever been given advice about any of the following by the pharmacist or pharmacy staff?
Stopping smoking Yes No
Healthy eating Yes No
Physical exercise Yes No
Q8  Which of the following best describes how you use this pharmacy?
This is the pharmacy that you choose to visit if possible
This is one of several pharmacies that you use when you need to
This pharmacy was just convenient for you today
Q9  Finally, taking everything into account - the staff, the shop and the service provided - how would you rate the pharmacy where you received this questionnaire?
Poor Fair Good Very good Excellent
Q10  If you have any comments about how the service from this pharmacy could be improved, please write them in here:
Q11  How old are you?
16-19 20-24 24-34 35-44 45-54 55-64 65+
Q12  Are you?
Male Female
Q13  Which of the following apply to you:
You have, or care for, children under 16
You are a carer for someone with a longstanding illness or infirmity
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