Customer Feedback

1. Which AuBurn Pharmacy location do you use?

2. How long have you been a customer of AuBurn Pharmacy?
This is my first time here
Less than 6 months
Six months to a year
1 – 2 years
3 or more years

3. If you answered “This is my first time here,” how likely are you to come back?
Extremely likely
Very likely
Somewhat likely
Not so likely
Not at all likely

4. Why did you choose AuBurn Pharmacy?
Referral from a family member
Referral from a friend
Referral from a doctor’s office
Location convenience

5. Overall, how satisfied or dissatisfied are you with the patient care offered by AuBurn Pharmacy?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied

6. Which of the following words would you use to describe AuBurn Pharmacy? Select all that apply
Good availability of products
Poor product selection
Long wait times
Short wait times

7. How well do our over the counter products meet your needs?
Extremely well
Very well
Somewhat well
Not so well
Not at all well

8. How would you rate the cost of our over the counter products?
Above average
Below average

9. How responsive have we been to your questions or concerns about your medicines?
Extremely responsive
Very responsive
Moderately responsive
Not so responsive
Not at all responsive

10. How likely is it that you would recommend AuBurn Pharmacy to a friend or colleague?

Customer Feedback (Continued)

11. How would you rate our store appearance?
a. Clean
Extremely clean
Very clean
Somewhat clean
Not so clean
Not at all clean
b. Shelves organized/faced
Extremely organized
Very organized
Somewhat organized
Not so clean
Not so organized
c. Staff appearance
Extremely neat, clean and professional
Very neat, clean and professional
Somewhat neat, clean and professional
Not so neat, clean and professional
Not at all neat, clean and professional

12. Patient satisfaction:
a. Were you greeted when you first walked in?
Yes No
b. Was your wait time satisfactory?
Yes No
c. Were you offered counseling?
Yes No
d. Was the staff friendly?
Yes No

13. Product availability:
a. Did the store have what you need?
Yes No
b. Did the staff offer to order it in?
Yes No

14. What would you like to see offered at our pharmacy that is not currently being offered?

15. What are we doing well/what do you like about our pharmacy?

16. What could we improve upon?

17. What is your gender?
Male Female

18. What is your age?

19. What is your current marital status?

20. What is the highest level of education you have completed?

Type the numbers:

Give us your feedback:

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