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1) Prior to this
submission how was your most recent prescription refill ordered?* |
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Comments:
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2) Do you feel
that you had adequate options available for submitting your
medication order?* |
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YesNo |
Comments:
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3) If you
submitted a prescription refill on-line, please rate your
experience. |
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10 = easy to use,
great website
1 = difficult to use
poor website |
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Comments:
If you rated less than 5,
please comment |
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4) If you
submitted a question to the website did you receive a timely,
clear answer? |
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YesNo
Not
applicable |
Comments:
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5) If your
previous prescription was submitted on-line in advance (website,
e-mail, phone, fax), was it ready when you arrived at the
pharmacy? |
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YesNo
Not
applicable |
Comments:
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6) Please rate
the helpfulness of the pharmacy staff.* |
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10 = Very helpful
1 = Not helpful at all |
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Comments:
If you rated less than 5,
please comment |
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7) Approximately
how long did you wait in the lobby for your prescription?* |
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Comments:
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8) How satisfied
are you with the lobby/facility resources?* |
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10 = Very satisfied
1 = No satisfaction |
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Comments:
If you rated less than 5,
please comment |
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9) How available
was the pharmacist to answer your medication questions?* |
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10 = Very available
1 = Not available |
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Comments:
If you rated less than 5, please comment |
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10) Did you
receive medication information from the pharmacist?* |
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YesNo |
Comments:
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Additional comments? |
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If you would like follow-up from
Pharmacy Leadership, please include your e-mail address. |
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For Patients:
