NHS Patient Survey
At our pharmacies, we always try to provide our customers with the best possible service.
To help us to improve the services we provide, we are asking our patients to fill in a short anonymous questionnaire.
Your views are important to us and it will only take a few minutes to complete.
We will use the results of this survey to improve the services we provide at our pharmacies
Please choose which pharmacy you visited:
If possible, please choose the date you visited the pharmacy
MM
/
DD
/
YYYY
1. What was the main purpose of your visit to the pharmacy today?
Required
2. If you collected a prescription (for yourself or someone else), did you...
3. If you collected a prescription or received a NHS service, how satisfied were you with the time it took?
4. Thinking about previous visits as well as your most recent visit, please rate the pharmacy on the following factors:
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 area
c) Having stock of medicines or appliances you needed
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
5. Thinking about previous visits as well as your most recent visit, please rate the pharmacist and the other pharmacy staff who work at the pharmacy on the following factors:
Very poor
Fairly poor
Fairly good
Very good
Don't know
a) Being polite and taking the time to listen
b) Answering any queries you may have
c) The service you received from the pharmacist
d) The service you received from the pharmacy staff
e) Providing an efficient service
f) The staff overall
6. Thinking about ALL the occasions you have used the pharmacy, how well do you think we provide each of the following services?
Very poor
Fairly poor
Fairly well
Very well
Never used
a) Providing advice on a current health problem or on a longer term health condition
b) Providing general advice on leading a healthier lifestyle
c) Disposing of medicines that you no longer need
d) Providing advice on health services or information available elsewhere
7. Have you ever received advice on any of the following from either the pharmacist or the pharmacy staff?
Please select all that apply, or choose NONE
Required
8. These questions relate to how we deal with your information and consent
After you receive NHS services or advice from our pharmacy, we may keep some of your health information so that we can help when you next visit the pharmacy. This information is always stored safely and kept absolutely confidential. Occasionally the pharmacist or pharmacy staff may ask for your consent to share your data with another healthcare professional to support your care. We will never pass on your health information without your express permission.
YES
NO
DON'T KNOW
Are you happy with our procedures to keep your information secure and confidential?
Has the pharmacist or pharmacy staff ever asked you for your consent to share information?
If you were asked for consent, do you feel that your wishes were respected?
9. Which of the following best describes why you use this pharmacy?
10. Taking everything in to account (the staff, the shop and the services provided), please rate the pharmacy:
11. How likely are you to recommend our pharmacy to your friends and family?
Next
Never submit passwords through Google Forms.
This form was created inside of H A McParland LTD. Report Abuse - Terms of Service - Additional Terms