Patient Satisfaction Survey
It is our desire to provide you with the best quality services available. In order to help us maintain our high standards, please take a few moments to tell us how we are doing.
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Survey Questions
*
Rows
Yes
No
Were your medications delivered on time?
Were the medications dispensed and delivered accurately?
Was the training provided effective in educating you on your therapy?
Are the educational materials and instructions provided to you adequate to educate you on the medications / products dispensed to you?
Was the pharmacy staff courteous and helpful?
Were your financial responsibilities explained to you?
Do you receive advice or help from the pharmacy when needed?
Did the services provided have a positive impact on the outcome of your care and/or therapy?
Would you recommend SwyftScripts to your friends and family?
Did the services provided meet your needs and expectations?
Overall satisfaction of service
Rows
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Friendliness
Knowledge
Responsiveness
How can we improve our service?
Submit
Should be Empty: