| 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)
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