Thank you for allowing us to provide you Pharmacy services. Please take a few minutes to give us
your feedback on your experience. We value your comments and welcome any suggestions you may have to improve our services.
MARKING INSTRUCTIONS:
Please fill in the box below for each question with an X.
Please explain any less than satisfied response(s) in the comment section below.

1.How would you rate your level of satisfaction with the following?(Required.)

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

The staff was courteous and helpful

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

I would recommend Rosemont to other physicians

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

The services provided met my needs and expectations

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

Rosemont is easier to use then other pharmacies

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

Rosemont helped improve my patient’s adherence with their compliance and care coordination

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

Ability to reach a person by phone who could answer your question

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

Explanation of whom to call if there is an issue with your order

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

2.How can we improve our services?

3.Comments:

4.Signature (Optional)