Your survey has been saved.
Thank you for taking the time to complete the survey.
You cannot access the survey at this time.
We apologize for the inconvenience.
Contact The Compliance Team
You cannot access the survey because the request has expired or the survey has already been submitted.
We apologize for the inconvenience.
Patient Satisfaction Survey — Community Pharmacy
Items below designated with an asterisk (
*
) are required.
Requested By:
Your Name:
First:
Last:
Your Phone #:
Use the following format (XXX) XXX-XXXX
New or Existing Patient:
*
New
Existing
Service:
*
Immunization
Medication Therapy Management
New Prescription
Other (Please Note in Comments)
Point of Care Test
Prescription Refill
Make or Serial # (as applicable):
Date of Service:
*
(mm/dd/yyyy format)
Clinician Name:
Unknown
Access, Delivery and Service
Yes
No
N/A
1
Responses to questions, concerns were addressed in a timely manner.
Reason:
Update Reason
2
Service friendly, prompt and courteous.
Reason:
Update Reason
3
Satisfied with the time spent with the Pharmacist.
Reason:
Update Reason
4
Did Pharmacist / Staff request info on other medications currently prescribed.
Reason:
Update Reason
5
Satisfied with medication counseling / instructions provided by the Pharmacist.
Reason:
Update Reason
6
Satisfied with the length of time for prescription processing.
Reason:
Update Reason
7
Received info on Patient Rights and Responsibilities.
Reason:
Update Reason
8
Satisfied with the service. Would recommend to others.
Reason:
Update Reason
COMMENTS:
We greatly appreciate your input. We use patient satisfaction survey reports to help us improve our day-to-day services. Please take an extra minute to provide details for your survey responses in the box below.
Question:
You answered, "No" for the question shown above. Using the text box below, please provide the details as to why you answered, "No".
Please provide your details in the text box above and then click the "Save" button below.
©2025 The Compliance Team, Inc. P.O. Box 160, 905 Sheble Lane, Suite 102, Spring House, PA 19477