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 Pharmacy Teammate
Product education/training provided
Quality of product/service received
All questions/concerns were addressed

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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

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

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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

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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?

T