Pharmacy Satisfaction Survey

Galen Pharmacy Patient Satisfaction Survey

Please rate your experience on a scale of 1-5. 1=Poor 5=Great
Name:

First NameLast Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
During your visit the staff was polite and helpful.
During your visit the pharmacy was clean and organized.
The staff was knowledgable about my medication(s)
The staff seemed truly interested in my health and wellness.
For medication deliveries, medications were delivered in a timely manner.
Wait times for appointments/medication dispensing.
Please rate the overall level of the service you received.
Questions or Comments:
Should be Empty:

Galen Pharmacy Patient Satisfaction Survey