This section is about why you visited the pharmacy today

Q1 Why did you visit this pharmacy today?

To collect a prescription for:


Note: If you did not collect a prescription, please go to Q3

Q2 If you collected a prescription today, were you able to collect it straight away, did you have to wait in the pharmacy or did you come back later to collect it?

Q3 How satisfied were you with the time it took to provide your prescription and/or any other NHS services you required?

This section is about the pharmacy and the staff who work there more generally, not just for today's visit

Q4 Thinking about any previous visits as well as today's, how would you rate the pharmacy on the following factors? Please tick one box for each aspect of the pharmacy listed below, to show how good or poor you think it is:

ANSWERS Very Poor Fairly Poor Fairly Good Very Good Don't know

Q5 Again, including any previous visits to this pharmacy, how would you rate the pharmacist and the other staff who work there? Please tick one box for each aspect of the service listed below, to show how good or poor you think it is:

ANSWERS Very Poor Fairly Poor Fairly Good Very Good Don't know

Q6 Thinking about all the times you have used this pharmacy, how well do you think it provides each of the following services?

ANSWERS Not at all well Not very well Fairly well Very well Never used

Q7 Have you ever been given advice about any of the following by the pharmacist or pharmacy staff?

Yes No
Yes No
Yes No

Q8 Which of the following best describes how you use this pharmacy?

Q9 Finally, taking everything into account - the staff, the shop and the service provided - how would you rate the pharmacy where you received this questionnaire?

Poor Fair Good Very good Excellent

Q10 If you have any comments about how the service from this pharmacy could be improved, please write them in here:

Q11 How old are you?

16-19 20-24 24-34 35-44 45-54 55-64 65+

Q12 Are you?

Male Female

Q13 Which of the following apply to you: