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Patient Satisfaction Survey

We would like to know how you feel about the services we provide.  Your responses are directly responsible for improving these services.  All responses will be kept confidential and anonymous.  Thank you for your time!

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* 1. Today's Date

Date

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* 2. What is your age?

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* 3. What is your Ethnicity

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* 4. Is this your first visit to our Pharmacy?

Please tell us how well you think we are doing in the following areas by using the ranking sections below.
EASE OF RECEIVING CARE:

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* 5. Hours Pharmacy is open

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* 6. Convenience of Pharmacy location

WAITING:

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* 7. Time Waiting

STAFF:

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* 8. Listens to you

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* 9. Takes enough time with you

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* 10. Communicates Clearly

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* 11. Explains what you want to know

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* 12. Friendly and helpful to you

PHONE:

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* 13. Phone calls answered promptly

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* 14. Time waiting on phone

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* 15. Calls returned in a timely manner

PAYMENT:

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* 16. Amount you pay

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* 17. Explanation of charges

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* 18. Collection of payment / money

FACILITY:

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* 19. Neat and Clean Building

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* 20. Comfort and safety while waiting

CONFIDENTIALITY:

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* 21. Our concern for your privacy

We appreciate your feedback on the following:

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* 22. How do you receive your prescriptions?

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* 23. How satisfied are you with the way you receive your prescriptions?

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* 24. Are you familiar with our Autofill Program?

***(Our Autofill Program automatically refills your maintenance medications 5 days before you are scheduled to run out.  Please contact us at (808) 240-0200 to find out more about tis convenient service)***

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* 25. Do you participate in our Autofill Program?

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* 26. If yes, how satisfied are you with this service?

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* 27. Do you use our automated refill line to enter your refill requests?

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* 28. Would you send your family and friends to us?

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* 29. What do you like best about our Pharmacy?

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* 30. What do you like least about our Pharmacy?

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* 31. Suggestions for improvement?

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* 32. Anyone who provided exceptional service you would like to mention?

WE APPRECIATE YOU TAKING THE TIME TO COMPLETE OUR SURVEY!!  MAHALO!
Patient Satisfaction Survey, Supported by funds from the Bureau of Primary Health Care
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