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Patient Survey

Community Pharmacy Patient Questionnaire

We always try to provide you with the best possible service, but we can never be perfect. Please answer the questions in this patient questionnaire so you can tell us where we can improve our service to you.

The patient questionnaire should take you just a couple of minutes to complete and the results are anonymous. These questions have been asked by the government and an action plan will be passed on to the PCT for evaluation.

Completing The Patient Questionnaire

Your answers are anonymous so that you can be free to tell us the honest truth ‘warts and all’.

If you find the online form too complicated, or you prefer to fill in a paper version with larger text, please ask at any Newline Pharmacy for the large text paper version.

The Patient Questionnaire

Please click the box that is closest to the way you feel.

Which of our pharmacies does this questionnaire relate to?

Newline Pharmacy, Dereham Terrace, Stakeford, NE62 5UR
Crescent Pharmacy, 110 Alexandra Road, Ashington, NE63 9LU
Backworth Pharmacy, Unit 2 Old Co-op Buildings, Church Road, Backworth, NE27 0JE
Coast Road Pharmacy, 11 Coast Road, Wallsend, NE28 9HP
Willington Quay Pharmacy, 13 Station Road, Willington Quay, NE28 6NB

Please fill in Today's Date Here:

Q1. Why did you visit this pharmacy today?

To collect a prescription for:

Yourself
Someone else
Both

OR...For some other reason (please write in the reason for your visit):

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?

Straight Away
Waited In The Pharmacy
Came Back Later

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

Very Satisfied
Fairly Satisfied
Not Very Satisfied
Not At All Satisfied

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:

Q4a. The cleanliness of the pharmacy

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q4b. The comfort and convenience of the waiting areas (eg: seating or standing room)

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q4c. Having in stock the medicines/appliances you need

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q4d. Having a clear and well organised layout

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q4e. How long you have to wait to be served

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q4f. Having somewhere available where you could speak without being overheard, if you wanted to

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q5. Again, including any previous visits to this pharmacy, how would you rate the pharmacist and any 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

Q5a. Being polite and taking the time to listen to what you want

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q5b. Answering any queries you may have

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q5c. The service you received from the pharmacist

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q5d. The service you received from the other pharmacy staff

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

Q5e. Providing an efficient service

Very Good
Fairly Good
Fairly Poor
Very Poor
Don't Know

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

Please tick one box for each of the services listed below

Q6a. Providing advice on a current health problem or a longer term health condition

Very Well
Fairly Well
Not Very Well
Not At All Well
Never Used

Q6b. Providing general advive on leading a more healthy lifestyle

Very Well
Fairly Well
Not Very Well
Not At All Well
Never Used

Q6c. Disposing of medicines you no longer need

Very Well
Fairly Well
Not Very Well
Not At All Well
Never Used

Q6d. Providing advice on health services or information available elsewhere

Very Well
Fairly Well
Not Very Well
Not At All Well
Never Used

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

Please indicate if the advice has been offered whether you personally needed it or not

Q7a. Stopping smoking

Yes
No

Q7b. Healthy Eating

Yes
No

Q7c. Physical Exercise

Yes
No

Q8. Which one 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 everything into account - the staff, the shop and the service provided - how would you rate the pharmacy this questionnaire relates to?

Excellent
Very Good
Good
Fair
Poor

Q10. If you have any comments on how the service from this pharmacy could be improved, please write them in the box below

Q11. This Question is about how we handle your information

Q11a. After you receive services or advice from us, we may retain some of your health information so that we can better help when you next visit the pharmacy. We always keep this information safely stored and kept absolutely confidential.

Yes
No

If you are happy with the way we do this then answer yes
Or if you have concerns then answer no

Q11b. In certain circumstances, the pharmacy may need to ask your consent to share your data with another healthcare professional to support your care. We will never pass on your health information without your express permission. Has the pharmacy ever asked for your consent like this?

Yes
No

Q11c. If yes, do you feel that your wishes were respected?

Yes
No

These last few questions are just to help us categorise your answers

Q12. How old are you?

16-19
20-24
25-34
35-44
45-54
55-64
65+

Q13. Are you...

Male
Female

Q14. Which of the following apply to you?

You have, or care for, children under 5
You have, or care for, children between 5 and 16
You are a carer for someone with a longstanding illness or infirmity
None of the above

Leave this field empty

Thank you for completing the Patient Questionnaire

All patient questionnaire replies are anonymous and will help us to constantly improve the service we offer at Newline Pharmacy.

Thank you for taking the time to complete the patient questionnaire.

Register with us today!

It's never been so easy. Simply call into your nearest branch and request to receive your electronic prescriptions at that respective pharmacy site. Alternatively, inform your surgery that you wish to make Newline your pharmacy of choice. We will handle all queries regarding ordering and repeat medication from there.

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