11 Dawley Road, Hayes, Middlesex, UB3 1LS

Patient Survey

This section is about why you visited the pharmacy today

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Why did you visit this pharmacy today?

Someone else
Why did you visit this pharmacy today?
To collect a prescription for:

For some other reason

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If you collected a prescription today, were you able to collect it...

Straight away
Waited in pharmacy
Came back later

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How satisfied were you with the time it took?
Not at all satisfied
Not very satisfied
Fairly satisfied
Very Satisfied

This section is about the pharmacy and the staff who work there more generally, not just for today's visit

Thinking about any previous visits as well as today's, how hould you rate the pharmacy on the following factors?
  Very poor Fairly poor Fairly good Very good Don't know
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a) The cleanliness of the pharmacy
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b) The comfort and convenience of the waiting areas (e.g. seating or standing room)
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c) Having in stock the medicines/appliances you need
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d) Offering a clear and well organised layout
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e) How long you have to wait to be served
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f) Having somewhere available where you could speak without being overheard, if you wanted to
Again, including any previous visits to this pharmacy, how would you rate the pharmacist and the other staff who work there?
  Very poor Fairly poor Fairly good Very good Don't know
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a) Being polite and taking the time to listen to what you want
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b) Answering any queries you may have
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c) The service you received from the pharmacist
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d) The service you received from the other pharmacy staff
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e) Providing an efficient service
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f) The staff overall

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

  Not at all well Not very well Fairly well Very well Never used
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a) Providing advice on a current health problem or a longer term health condition
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b) Providing general advice on leading a more healthy lifestyle
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c) Disposing of medicines you no longer need
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d) Providing advice on health services or information available elsewhere
Have you ever been given advice about any of the following by the pharmacist or pharmacy staff?
  Yes No  
Stopping smoking Please Select
Healthy eating Please Select
Physical exercise Please Select
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Which 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
Finally, taking everything into account - the staff, the shop and the service provided - how would you rate the pharmacy where you received this questionnaire?
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Poor Fair Good Very Good Excellent
If you have any comments about how the service from this pharmacy could be improved, please write them in here:

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

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How old are you?
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Are you ...
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Which of the following apply to you:
  You have, or care for, children under 16
  You are a carer for someone with a longstanding illness of infirmity

Thank you for completing this questionnaire

Repeat Prescriptions

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Opening Hours
Monday - Friday
9am - 1pm & 2pm - 6:30pm
9am - 1pm

NHS Hillingdon

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