Q1 Why did you visit this pharmacy today? To collect a prescription for:

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?

Q4 Thinking about any previous visits as well as today’s, how would you rate the pharmacy on the following factors?

1. The cleanliness of the pharmacy ...............................................................................
2. The comfort and convenience of the waiting areas (e.g. Seating or standing room)
3. Having in stock the medicines/appliances you need .................................................
4. Offering a clear and well organised layout .................................................................
5. How long you wait to be served .................................................................................
6. Having somewhere available where you could speak without being overheard, if you wanted to .............................................................................................................

Q5 Again, including any previous visits to this pharmacy, how would you rate the pharmacist and the other staff who work there?

1. Being polite and taking the time to listen to what you want ........................................
2. Answering any queries you may have ........................................................................
3. The service you received from the pharmacist ..........................................................
4. The service you received from the other pharmacy staff ..........................................
5. Providing an efficient service ......................................................................................
6. The staff overall ..........................................................................................................

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

1. Providing advice on a current health problem or a longer term health condition .......
2. Providing general advice on leading a more healthy lifestyle .....................................
3. Disposing of medicines you no longer need ..............................................................
4. Providing advice on health services or information available elsewhere ...................

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

Stopping smoking .............................................

Healthy eating ....................................................

Physical exercise ..............................................

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

This is the pharmacy that you choose to visit if possible .............................................

This is one of several pharmacies that you use when you need to .............................

This pharmacy was just convenient for you today .......................................................

Q9 Finally, taking into account - the staff, the shop and the services provided - how would you rate the pharmacy that you visited?

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

Q11 How old are you? ..................................................................

Q12 Are you .................................................................................

Q13 Which of the following apply to you:

You have, or care for children under 16 ................................................................

You are a carer for someone with a longstanding illness or infirmity ....................

Neither ....................................................................................................................

Thank you for completing this questionnaire. Please click the submit button to send the information to our head office.

Before completing the questionnaire, let us know which of our pharmacies you visited