Page 1

Please look at the questions before your visit and answer them afterwards.
Please do not take the questionnaire with you to the pharmacy.
Please do not announce yourself as being a mystery shopper or as being from Healthwatch Derby.


Please enter the following information into the box below:

Name of Healthwatcher

Visit to

Date of visit

 

1. Question 1.

Is the pharmacy easily accessible (walking/public transport/driving)?

Very easy

Fairly easy

Not very easy

Not at all easy

2. Question 2.

Is there a ramp or flat access?

Yes

No

Don't know

3. Question 3.

Can wheelchair users and people with mobility issues get in easily?

Very easy

Fairly easy

Not very easy

Not at all easy

Comments

4. Question 4.

Are there signs providing information in your first language?

Yes

No

Don't know

5. Question 5.

Were you acknowledged on arrival (eye contact, smiles, a greeting)?

Yes

No

Don't know

6. Question 6.

Did the staff make you feel welcome and at ease?

Yes

No

Don't know

7. Question 7.

Does the environment appear to be clean and well maintained?

Yes

No

Don't know

Comments

8. Question 8.

Is information available clear and visible?

Yes

No

Don't know

9. Question 9.

Is there hand gel available?

Yes

No

Don't know

10. Question 10.

Is there information about the staff members and the person in charge?

Yes

No

Don't know

11. Question 11.

Are security and fire procedures evident?

Yes

No

Don't know

Comments

12. Question 12.

How long did you wait to be seen?

Less than 10 minutes

10-20 minutes

More than 20 minutes

13. Question 13.

How long did you have to wait for your prescription?

Less than 10 minutes

10-20 minutes

More than 20 minutes

Not applicable

Comments

14. Question 14.

Was the person you saw helpful?

Very helpful

Fairly helpful

Not very helpful

Not at all helpful

15. Question 15.

Was there somewhere you could talk in private if you wished?

Yes

No

Don't know

16. Question 16.

Did they give you all the information you needed?

Yes

No

Don't know

17. Question 17.

Were you able to ask questions?

Yes

No

Don't know

18. Question 18.

Did they explain your treatment and/or medication and what happens next?

Yes

No

Don't know

Comments

19. Question 19.

How likely are you to recommend this pharmacy to friends or family if they needed similar care or treatment?

Extremely likely

Likely

Neither likely nor unlikely

Unlikely

Extremely unlikely

Don't know

Comments

Anything else?

Comments