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:

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.

Q3 - How satisfied were you with the time it took to provide your prescription and/or any other NHS services you required?

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


The cleanliness of the pharmacy

The comfort and convenience of the waiting areas (e.g. seating or standing room)

Having in stock the medicines/appliances you need

Offering a clear and well organised layout

How long you have to wait to be served

Having somewhere available where you could speak without being overheard, if you wanted to

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


Being polite and taking the time to listen to what you want

Answering any queries you may have

The service you received from the pharmacist

The service you received from the other pharmacy staff

Providing an efficient service

The staff overall

Q6 - Thinking about all the times you have used this pharmacy, how well do you think it


Providing advice on a current health problem or a longer term health condition

Providing general advice on leading a more healthy lifestyle

Disposing of medicines you no longer need

Providing advice on health services or information available elsewhere

Q7 - Have you ever been given advice about any of the following by the pharmacist or


Stopping smoking

Healthy eating

Physical exercise

Q8 - Which of the following best describes how you use this pharmacy?

Q9 - Finally, taking everything into account - the staff, the shop and the service provided -

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?

Q12 - Are you…

Q13 - Which of the following apply to you: