Pharmacy Performance

Pharmacy Patient Satisfaction Survey

Providing excellent customer service is a top priority for Price Chopper/Market 32 Pharmacy. Thank you for taking the time to participate in this survey.

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* 1. Please rate your degree of satisfaction on a scale of 1 (completely dissatisfied) to 5 (completely satisfied) or select N/A if not applicable.

	Completely Dissatisfied	Somewhat Dissatisfied	Neutral	Somewhat Satisfied	Completely Satisfied	N/A
Customer service provided by the pharmacist	Customer service provided by the pharmacist Completely Dissatisfied	Customer service provided by the pharmacist Somewhat Dissatisfied	Customer service provided by the pharmacist Neutral	Customer service provided by the pharmacist Somewhat Satisfied	Customer service provided by the pharmacist Completely Satisfied	Customer service provided by the pharmacist N/A
Customer service provided by Pharmacy Teammate	Customer service provided by Pharmacy Teammate Completely Dissatisfied	Customer service provided by Pharmacy Teammate Somewhat Dissatisfied	Customer service provided by Pharmacy Teammate Neutral	Customer service provided by Pharmacy Teammate Somewhat Satisfied	Customer service provided by Pharmacy Teammate Completely Satisfied	Customer service provided by Pharmacy Teammate N/A
Product education/training provided	Product education/training provided Completely Dissatisfied	Product education/training provided Somewhat Dissatisfied	Product education/training provided Neutral	Product education/training provided Somewhat Satisfied	Product education/training provided Completely Satisfied	Product education/training provided N/A
Quality of product/service received	Quality of product/service received Completely Dissatisfied	Quality of product/service received Somewhat Dissatisfied	Quality of product/service received Neutral	Quality of product/service received Somewhat Satisfied	Quality of product/service received Completely Satisfied	Quality of product/service received N/A
All questions/concerns were addressed	All questions/concerns were addressed Completely Dissatisfied	All questions/concerns were addressed Somewhat Dissatisfied	All questions/concerns were addressed Neutral	All questions/concerns were addressed Somewhat Satisfied	All questions/concerns were addressed Completely Satisfied	All questions/concerns were addressed N/A

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* 2. Overall I am satisfied with Price Chopper/Market 32 Pharmacy.

agree

somewhat agree

neutral

somewhat disagree

completely disagree

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* 3. Please choose Yes or No

	Yes	No	N/A
Your name and date of birth were confirmed by a Teammate at the pharmacy checkout.	Your name and date of birth were confirmed by a Teammate at the pharmacy checkout. Yes	Your name and date of birth were confirmed by a Teammate at the pharmacy checkout. No	Your name and date of birth were confirmed by a Teammate at the pharmacy checkout. N/A
A Teammate asked if you had any questions for the pharmacist or if you would like to be counseled on your prescriptions.	A Teammate asked if you had any questions for the pharmacist or if you would like to be counseled on your prescriptions. Yes	A Teammate asked if you had any questions for the pharmacist or if you would like to be counseled on your prescriptions. No	A Teammate asked if you had any questions for the pharmacist or if you would like to be counseled on your prescriptions. N/A
A Teammate reviewed your co-payments and final charges with you to make sure they were correct at the pharmacy checkout.	A Teammate reviewed your co-payments and final charges with you to make sure they were correct at the pharmacy checkout. Yes	A Teammate reviewed your co-payments and final charges with you to make sure they were correct at the pharmacy checkout. No	A Teammate reviewed your co-payments and final charges with you to make sure they were correct at the pharmacy checkout. N/A
You were provided an attestation form to sign, where applicable.	You were provided an attestation form to sign, where applicable. Yes	You were provided an attestation form to sign, where applicable. No	You were provided an attestation form to sign, where applicable. N/A

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* 4. Please add any comments about your PriceChopper/Market32 Pharmacy experience.

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* 5. Enter Date of Service

Date / Time

Date

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* 6. Please enter the store number or the city of the Price Chopper/Market32 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)

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* 7. Please select all that apply.
What pharmacy service were you provided?

Prescription Filling

Vaccination ( for example: flu, pneumonia, shingles)

Counseling on medications or over-the-counter products

Other

Other (please explain)

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* 8. Please enter your AdvantEdge card number (OPTIONAL)

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* 9. May we contact you?

Yes

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* 1. Please rate your degree of satisfaction on a scale of 1 (completely dissatisfied) to 5 (completely satisfied) or select N/A if not applicable.

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* 2. Overall I am satisfied with Price Chopper/Market 32 Pharmacy.

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* 3. Please choose Yes or No

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* 4. Please add any comments about your PriceChopper/Market32 Pharmacy experience.

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* 5. Enter Date of Service

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* 6. Please enter the store number or the city of the Price Chopper/Market32 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)

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* 7. Please select all that apply.What pharmacy service were you provided?

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* 8. Please enter your AdvantEdge card number (OPTIONAL)

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* 9. May we contact you?

* 7. Please select all that apply.
What pharmacy service were you provided?