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1) Which facility did you visit?
   
2) Prior to this submission how was your most recent prescription refill ordered?
  Comments:
3) Do you feel that you had adequate options available for submitting your medication order?
  Comments:
4) If you submitted a prescription refill on-line, please rate your experience.
10 = easy to use, great website
1 = difficult to use poor website
Comments:
5) If you submitted a question to the website did you receive a timely, clear answer?
  Comments:
6) If your previous prescription was submitted online in advance (website, e-mail, phone, fax), was it ready when you arrived at the pharmacy?
  Comments:
7) Please rate the helpfulness of the pharmacy staff.
10 = Very helpful
1 = Not helpful at all
Comments:
8) Approximately how long did you wait in the lobby for your prescription?
  Comments:
9) How satisfied are you with the lobby/facility resources?
10 = Very satisfied
1 = No satisfaction
Comments:
10) How available was the pharmacist to answer your medication questions?
10 = Very available
1 = Not available
Comments:
11) Did you receive medication information from the pharmacist?
  Comments:
Additional Comments?
If you would like a follow-up from Pharmacy Leadership, please include your e-mail address.
  E-mail Address: