Community Pharmacy Patient Questionnaire
This section is about why you visited the pharmacy today
Q1 - Why did you visit this pharmacy today?
To collect a prescription for:
Yourself
Someone else
Both
Some other reason
Max 250 characters allowed
Q2 - If you collected a prescription today, were you able to collect it straight away, did you have to wait in the pharmacy or did you come back later to collect it?
If you did not collect a prescription, please go to Q3.
Straight away
Waited in pharmacy
Came back later
Q3 - How satisfied were you with the time it took to provide your prescription and/or any other NHS services you required?
Not at all satisfied
Not very satisfied
Fairly satisfied
Very Satisfied
This section is about the pharmacy and the staff who work there more generally, not just for today's visit
Q4 - Thinking about any previous visits as well as today's, how would you rate the pharmacy on the following factors? Please tick one box for each aspect of the pharmacy listed below, to show how good or poor you think it is:
Please tick one box for each aspect of the pharmacy
ANSWERS:
The cleanliness of the pharmacy
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
The comfort and convenience of the waiting areas (e.g. seating or standing room)
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
Having in stock the medicines/appliances you need
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
Offering a clear and well organised layout
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
How long you have to wait to be served
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
Having somewhere available where you could speak without being overheard, if you wanted to
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
Q5 - Again, including any previous visits to this pharmacy, how would you rate the pharmacist and the other staff who work there?
Please tick one box for each aspect of the
ANSWERS:
Being polite and taking the time to listen to what you want
Very Poor
Faily Poor
Fairly Good
Very Good
Don't Know
Answering any queries you may have
Very Poor
Faily Poor
Fairly Good
Very Good
Don't Know
The service you received from the pharmacist
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
The service you received from the other pharmacy staff
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
Providing an efficient service
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
The staff overall
Very Poor
Fairly Poor
Fairly Good
Very Good
Don't Know
Q6 - Thinking about all the times you have used this pharmacy, how well do you think it
ANSWERS:
Providing advice on a current health problem or a longer term health condition
Not At All Well
Not Very Well
Fairly Well
Very Well
Never Used
Providing general advice on leading a more healthy lifestyle
Not At All Well
Not Very Well
Fairly Well
Very Well
Never Used
Disposing of medicines you no longer need
Not At All Well
Faily Poor
Fairly Good
Very Good
Never Used
Providing advice on health services or information available elsewhere
Not Very Well
Faily Well
Fairly Well
Very Well
Never Used
Q7 - Have you ever been given advice about any of the following by the pharmacist or
ANSWERS:
Stopping smoking
Yes
No
Healthy eating
Yes
No
Physical exercise
Yes
No
Q8 - Which of the following best describes how you use this pharmacy?
This is the pharmacy that you choose to visit if possible
This is one of several pharmacies that you use when you need to
This pharmacy was just convenient for you today
Q9 - Finally, taking everything into account - the staff, the shop and the service provided -
Poor
Fair
Good
Very Good
Excellent
Q10 - If you have any comments about how the service from this pharmacy could be
Max 250 characters allowed
These last few questions are just to help us categorise your answers
Q11 - How old are you?
16-19
20-24
25-34
35-44
45-54
55-64
65+
Q12 - Are you…
Male
Female
Q13 - Which of the following apply to you:
You have, or care for, children under 16
You are a carer for someone with a longstanding illness or infirmity…
Neither
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