Patient Survey

* Dear Patient,
We would like your feedback on our services. Please take a moment to fill out this survey.

  (1) DISSATISFIED (2) SOMEWHAT SATISFIED (3) SATISFIED (4) VERY SATISFIED (5) COMPLETELY SATISFIED
TIMELINESS OF FILL / DELIVERY
CONDITION OF MEDICATION WHEN FILLED / RECEIVED
ACCURACY OF THE FILLED PRESCRIPTION
EASE IN SPEAKING WITH A PHARMACIST OR NURSE
EMPATHY / CONCERN FOR PATIENT’S NEEDS
KNOWLEDGE OF HEALTH CONDITION, MEDICATION, AND ABILITY TO ANSWER QUESTIONS
EASE OF ENROLLMENT
SERVICE RATINGS FOR BOTH INITIAL FILLS AND REFILLS
OVERALL EXPERIENCE WITH PROVIDER
OVERALL SERVICE SATISFACTION

* Do you have any other comments, questions, or concerns?

T