Phone: (01923) 825288
3-4 Clive Parade, Maxwell Road
                  Northwood, HA6 2QF
Home > Patient Survey
PATIENT SURVEY
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
OR
Note: If you did not collect a prescription, please go to Q3
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?
Straight away
Waited in pharmacy
Come 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:
ANSWERS:
Very poor
Fairly poor
Fairly good
Very good
Don't know
a)   The cleanliness of the pharmacy
b)   The comfort and convenience of the waiting areas (e.g.
      seating or standing room)
c)    Having in stock the medicines/appliances you need
d)   Offering a clear and well organised layout
e)   How long you have to wait to be served
f)   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 service listed below, to show how good or poor you think it is:
ANSWERS:
Very poor
Fairly poor
Fairly good
Very good
Don't know
a)   Being polite and taking the time to listen to what you want
b)   Answering any queries you may have
c)   The service you received from the pharmacist
d)   The service you received from the other pharmacy staff
e)   Providing an efficient service
f)   The staff overall
Q6   Thinking about all the times you have used this pharmacy, how well do you think it provides each of the following services?
ANSWERS:
Not at all well
Not very well
Fairly well
Very well
Never used
a)   Providing advice on a current health problem or a longer       term health condition
b)   Providing general advice on leading a more healthy lifestyle
c)    Disposing of medicines you no longer need
d)    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 pharmacy staff?
Stopping smoking
Healthy eating
Physical exercise
Yes
No
Yes
No
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 - how would you rate the pharmacy where you
       received this questionnaire?
Poor
Fair
Good
Very good
Excellent
Q10   If you have any comments about how the service from this pharmacy could be improved, please write them in here:
Q11   How old are you?
16-19
20-24
24-34
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
Thank you for completing this questionnaire