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.



Q1. Why did you visit this pharmacy today?


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



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:

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

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

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




Q11. This Question is about how we handle your information

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

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





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.