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Tops Pharmacy Patient Satisfaction Survey
Providing excellent customer service is a top priority for Tops Specialty Pharmacy. Thank you for taking the time to participate in this survey.
1.
Please rate your degree of satisfaction on a scale of 1 (completely dissatisfied) to 5 (completely satisfied)
Completely Dissatisifed
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Completely Satisfied
Customer service provided by the pharmacist
Completely Dissatisifed
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Completely Satisfied
Customer service provided by the pharmacy associate
Completely Dissatisifed
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Completely Satisfied
Product education/training provided
Completely Dissatisifed
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Completely Satisfied
Quality of product/service received
Completely Dissatisifed
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Completely Satisfied
All questions/concerns were addressed
Completely Dissatisifed
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Completely Satisfied
2.
Overall I am satisfied with Tops Markets Specialty Pharmacy
Agree
Somewhat Agree
Neutral
Somewhat Disagree
Completely Disagree
3.
Please Choose Yes or No to the following:
Yes
No
N/A
Your name and date of birth were confirmed by an associate at the pharmacy checkout
Yes
No
N/A
An associate asked if you had any questions for the pharmacist or if you would like to be counseled on your prescription
Yes
No
N/A
An associate reviewed your co-payments and final charges with you to make sure they were correct at the pharmacy checkout
Yes
No
N/A
You were provided an attestation form to sign, where applicable
Yes
No
N/A
4.
Please add any comments about your Tops Markets Specialty Program experience.
5.
Enter Date of Service
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
6.
Please enter the store number or the city of the Tops Markets Pharmacy you visited. The store number is the 3 digit number after the prescription number on your pharmacy receipt or prescription label. (ex. Rx# 1234567- 112).
7.
What pharmacy service were you provided? Please select all that apply
Prescription Filling
Vaccination (for example: flu, pneumonia, shingles)
Counseling on medications or over-the-counter products
Other (please specify)
8.
May we contact you?
Yes
No
Contact information
