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PMC Specialty Pharmacy Patient Satisfaction Survey
Rate your experience with each.
How satisfied were you with the education provided about your medication? Completely Satisfied

Somewhat Satisfied

Satisfied

Somewhat Dissatisfied

Very Dissatisfied
How satisfied were you with the education and counseling provided about your health condition or problem? Completely Satisfied

Somewhat Satisfied

Satisfied

Somewhat Dissatisfied

Very Dissatisfied
How satisfied were you with our pharmacy staff to quickly answer questions and/or resolve any issues? Completely Satisfied

Somewhat Satisfied

Satisfied

Somewhat Dissatisfied

Very Dissatisfied
How satisfied were you with the condition and accuracy of your filled prescription? Completely Satisfied

Somewhat Satisfied

Satisfied

Somewhat Dissatisfied

Very Dissatisfied
How satisfied were you with the speed at which your medication was delivered? Completely Satisfied

Somewhat Satisfied

Satisfied

Somewhat Dissatisfied

Very Dissatisfied
How often were you able to talk to our pharmacy staff about your health or your filled prescription? Always

Usually

Sometimes

Never

Somewhat Dissatisfied

Very Dissatisfied
Do you want to provide any additional comments or suggestions? (Please do not enter identifying information or diagnosis
information here. This form is not secure for that purpose)