Clarendon Pharmacy

Question Title

* Q1. Why did visit this pharmacy today?
To obtain a prescription for:

Yourself

Someone else

Both

For some OTHER reason (please write in the reason for your visit):

If you did not collect a prescription, please go to Q3.

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* 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

Came back later

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* 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

Please tick one box for each aspect of the pharmacy listed below, to show how good or poor you think it is:

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* 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:

	Very poor	Fairly poor	Fairly good	Very good	Don't know
a) The cleanliness of the pharmacy....………….	a) The cleanliness of the pharmacy....…………. Very poor	a) The cleanliness of the pharmacy....…………. Fairly poor	a) The cleanliness of the pharmacy....…………. Fairly good	a) The cleanliness of the pharmacy....…………. Very good	a) The cleanliness of the pharmacy....…………. Don't know
b) The comfort and convenience of the waiting areas (e.g. seating or standing room)..	b) The comfort and convenience of the waiting areas (e.g. seating or standing room).. Very poor	b) The comfort and convenience of the waiting areas (e.g. seating or standing room).. Fairly poor	b) The comfort and convenience of the waiting areas (e.g. seating or standing room).. Fairly good	b) The comfort and convenience of the waiting areas (e.g. seating or standing room).. Very good	b) The comfort and convenience of the waiting areas (e.g. seating or standing room).. Don't know
c) Having in stock the medicines/appliances you need ……………………………………………..	c) Having in stock the medicines/appliances you need …………………………………………….. Very poor	c) Having in stock the medicines/appliances you need …………………………………………….. Fairly poor	c) Having in stock the medicines/appliances you need …………………………………………….. Fairly good	c) Having in stock the medicines/appliances you need …………………………………………….. Very good	c) Having in stock the medicines/appliances you need …………………………………………….. Don't know
d) Offering a clear and well organised layout...............................	d) Offering a clear and well organised layout............................... Very poor	d) Offering a clear and well organised layout............................... Fairly poor	d) Offering a clear and well organised layout............................... Fairly good	d) Offering a clear and well organised layout............................... Very good	d) Offering a clear and well organised layout............................... Don't know
e) How long you have to wait to be served …...............................…….............	e) How long you have to wait to be served …...............................……............. Very poor	e) How long you have to wait to be served …...............................……............. Fairly poor	e) How long you have to wait to be served …...............................……............. Fairly good	e) How long you have to wait to be served …...............................……............. Very good	e) How long you have to wait to be served …...............................……............. Don't know
f) Having somewhere available where you could speak without being overheard, if you wanted to...	f) Having somewhere available where you could speak without being overheard, if you wanted to... Very poor	f) Having somewhere available where you could speak without being overheard, if you wanted to... Fairly poor	f) Having somewhere available where you could speak without being overheard, if you wanted to... Fairly good	f) Having somewhere available where you could speak without being overheard, if you wanted to... Very good	f) Having somewhere available where you could speak without being overheard, if you wanted to... Don't know

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* 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:

	Very poor	Fairly poor	Fairly good	Very good	Don't know
a) Being polite and taking the time to listen to what you want …………………………………….	a) Being polite and taking the time to listen to what you want ……………………………………. Very poor	a) Being polite and taking the time to listen to what you want ……………………………………. Fairly poor	a) Being polite and taking the time to listen to what you want ……………………………………. Fairly good	a) Being polite and taking the time to listen to what you want ……………………………………. Very good	a) Being polite and taking the time to listen to what you want ……………………………………. Don't know
b) Answering any queries you may have…..…….. …	b) Answering any queries you may have…..…….. … Very poor	b) Answering any queries you may have…..…….. … Fairly poor	b) Answering any queries you may have…..…….. … Fairly good	b) Answering any queries you may have…..…….. … Very good	b) Answering any queries you may have…..…….. … Don't know
c) The service you received from the pharmacist …………………………………………..	c) The service you received from the pharmacist ………………………………………….. Very poor	c) The service you received from the pharmacist ………………………………………….. Fairly poor	c) The service you received from the pharmacist ………………………………………….. Fairly good	c) The service you received from the pharmacist ………………………………………….. Very good	c) The service you received from the pharmacist ………………………………………….. Don't know
d) The service you received from the other pharmacy staff ………………………………………	d) The service you received from the other pharmacy staff ……………………………………… Very poor	d) The service you received from the other pharmacy staff ……………………………………… Fairly poor	d) The service you received from the other pharmacy staff ……………………………………… Fairly good	d) The service you received from the other pharmacy staff ……………………………………… Very good	d) The service you received from the other pharmacy staff ……………………………………… Don't know
e) Providing an efficient service	e) Providing an efficient service Very poor	e) Providing an efficient service Fairly poor	e) Providing an efficient service Fairly good	e) Providing an efficient service Very good	e) Providing an efficient service Don't know
f) The staff overall	f) The staff overall Very poor	f) The staff overall Fairly poor	f) The staff overall Fairly good	f) The staff overall Very good	f) The staff overall Don't know

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* Q6 Thinking about all the times you have used this pharmacy, how well do you think it provides each of the following services? Please tick one box for each aspect of the service listed below, to show how good or poor you think it is:

	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	a) Providing advice on a current health problem or a longer term health condition Not at all well	a) Providing advice on a current health problem or a longer term health condition Not very well	a) Providing advice on a current health problem or a longer term health condition Fairly well	a) Providing advice on a current health problem or a longer term health condition Very well	a) Providing advice on a current health problem or a longer term health condition Never used
b) Providing general advice on leading a more healthy lifestyle	b) Providing general advice on leading a more healthy lifestyle Not at all well	b) Providing general advice on leading a more healthy lifestyle Not very well	b) Providing general advice on leading a more healthy lifestyle Fairly well	b) Providing general advice on leading a more healthy lifestyle Very well	b) Providing general advice on leading a more healthy lifestyle Never used
c) Disposing of medicines you no longer need	c) Disposing of medicines you no longer need Not at all well	c) Disposing of medicines you no longer need Not very well	c) Disposing of medicines you no longer need Fairly well	c) Disposing of medicines you no longer need Very well	c) Disposing of medicines you no longer need Never used
d) Providing advice on health services or information available elsewhere	d) Providing advice on health services or information available elsewhere Not at all well	d) Providing advice on health services or information available elsewhere Not very well	d) Providing advice on health services or information available elsewhere Fairly well	d) Providing advice on health services or information available elsewhere Very well	d) Providing advice on health services or information available elsewhere Never used

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* Q7 Have you ever been given advice about any of the following by the pharmacist or pharmacy staff?

	Yes	No
Stop smoking	Stop smoking Yes	Stop smoking No
Healthy eating	Healthy eating Yes	Healthy eating No
Physical exercise	Physical exercise Yes	Physical exercise No

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* 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

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* Q9 Finally, taking everything into account - the staff, the shop and the service provided - how would you rate this pharmacy where you received this questionnaire?

Poor

Fair

Good

Very Good

Excellent

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* Q10 If you have any comments about how the service from this pharmacy could be improved, please write them in here:

These last few questions are just to help us categorise your answers

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* Q11 How old are you?

16-19

20-24

25-34

35-44

45-54

55-64

65+

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* Q12 Are you...

Male

Female

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* 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

Neither

Question Title

* Q1. Why did visit this pharmacy today?To obtain a prescription for:

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* 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?

Question Title

* Q3 How satisfied were you with the time it took to provide your prescription and/or any other NHS services you required?

Question Title

* 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:

Question Title

* 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:

Question Title

* Q6 Thinking about all the times you have used this pharmacy, how well do you think it provides each of the following services? Please tick one box for each aspect of the service listed below, to show how good or poor you think it is:

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* Q7 Have you ever been given advice about any of the following by the pharmacist or pharmacy staff?

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* Q8 Which of the following best describes how you use this pharmacy?

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* Q9 Finally, taking everything into account - the staff, the shop and the service provided - how would you rate this pharmacy where you received this questionnaire?

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* Q10 If you have any comments about how the service from this pharmacy could be improved, please write them in here:

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* Q11 How old are you?

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* Q12 Are you...

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* Q13 Which of the following apply to you?

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* Sign with your initials to complete

* Q1. Why did visit this pharmacy today?
To obtain a prescription for: