Patient Satisfaction Survey – AdvanceCare Rx Pharmacies

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Name (optional)

Email (optional)

Please rate each statement using the scale below.

1 = Strongly disagree
2 = Disagree
3 = Agree
4 = Strongly Agree

1. The pharmacy staff are polite and helpful.(Required)

1

2

3

4

2. The pharmacy delivered my medication(s) on time.(Required)

1

2

3

4

3. The pharmacy staff seem to understand my medication(s).(Required)

1

2

3

4

4. The pharmacy staff seem to care about my health.(Required)

1

2

3

4

5. Please write any comments about your experience at the pharmacy