Prescription Access Feedback Survey Form
Please share your experience with prescription access. Your feedback helps us improve our services. This survey does not collect sensitive personal or health information.
How easy was it to access your prescription?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
How satisfied are you with the overall prescription access process?
*
1
2
3
4
5
Which method did you use to access your prescription?
*
In-person pickup
Mail order
Online pharmacy
Other
How clear were the instructions for obtaining your prescription?
*
Not Clear
1
2
3
4
Very Clear
5
1 is Not Clear, 5 is Very Clear
How long did it take to receive your prescription after ordering?
*
Same day
1-2 days
3-5 days
More than 5 days
Did you experience any barriers in accessing your prescription?
*
No barriers
Cost
Insurance issues
Pharmacy hours
Other
How helpful was the staff in assisting you with your prescription?
*
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
How likely are you to recommend our prescription access process to others?
*
Not Likely
1
2
3
4
Very Likely
5
1 is Not Likely, 5 is Very Likely
What could be improved about the prescription access process?
Additional comments or suggestions
Submit Feedback
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