Pharmacy Service Satisfaction Survey
Please let us know about your experience with our products and service.
Which ACME Pharmacy location did you visit?
Would you recommend it to your friends and colleagues?
Yes
No
How satisfied are you with our company overall?
Very Unsatisfied
1
2
3
4
Very Satisfied
5
1 is Very Unsatisfied, 5 is Very Satisfied
Please evaluate the pharmacy staff:
*
Rows
Don’t Know
Poor
Fair
Good
Great
Service Quality
1
2
3
4
5
Responsiveness
6
7
8
9
10
Kindness and Helpfulness
11
12
13
14
15
Friendliness/politeness
16
17
18
19
20
Answers the phone/returns phone calls
21
22
23
24
25
Fills your prescriptions on time
26
27
28
29
30
Maintains your privacy
31
32
33
34
35
Answers your questions
36
37
38
39
40
Provides advice on medications and healthcare services
41
42
43
44
45
Counsels you on your new prescription medications
46
47
48
49
50
Overall customer service
51
52
53
54
55
Likelihood of you referring us to a friend or family member
56
57
58
59
60
What do you like best about our pharmacy?
What do you like least about our pharmacy?
Suggestions for improvement?
Please leave your email address if you would like us to contact you regarding any questions.
Full Name
First Name
Last Name
E-mail Address
example@example.com
Submit
Should be Empty: