Physician Satisfaction Survey

Thank you for allowing us to provide you Pharmacy services. Please take a few minutes to give us
your feedback on your experience. We value your comments and welcome any suggestions you may have to improve our services.
MARKING INSTRUCTIONS:
Please fill in the box below for each question with an X.
Please explain any less than satisfied response(s) in the comment section below.

	Very Satisfied	Satisfied	Somewhat Satisfied	Neutral	Somewhat Dissatisfied	Dissatisfied	N/A
The staff was courteous and helpful	The staff was courteous and helpful Very Satisfied	The staff was courteous and helpful Satisfied	The staff was courteous and helpful Somewhat Satisfied	The staff was courteous and helpful Neutral	The staff was courteous and helpful Somewhat Dissatisfied	The staff was courteous and helpful Dissatisfied	The staff was courteous and helpful N/A
I would recommend Rosemont to other physicians	I would recommend Rosemont to other physicians Very Satisfied	I would recommend Rosemont to other physicians Satisfied	I would recommend Rosemont to other physicians Somewhat Satisfied	I would recommend Rosemont to other physicians Neutral	I would recommend Rosemont to other physicians Somewhat Dissatisfied	I would recommend Rosemont to other physicians Dissatisfied	I would recommend Rosemont to other physicians N/A
The services provided met my needs and expectations	The services provided met my needs and expectations Very Satisfied	The services provided met my needs and expectations Satisfied	The services provided met my needs and expectations Somewhat Satisfied	The services provided met my needs and expectations Neutral	The services provided met my needs and expectations Somewhat Dissatisfied	The services provided met my needs and expectations Dissatisfied	The services provided met my needs and expectations N/A
Rosemont is easier to use then other pharmacies	Rosemont is easier to use then other pharmacies Very Satisfied	Rosemont is easier to use then other pharmacies Satisfied	Rosemont is easier to use then other pharmacies Somewhat Satisfied	Rosemont is easier to use then other pharmacies Neutral	Rosemont is easier to use then other pharmacies Somewhat Dissatisfied	Rosemont is easier to use then other pharmacies Dissatisfied	Rosemont is easier to use then other pharmacies N/A
Rosemont helped improve my patient’s adherence with their compliance and care coordination	Rosemont helped improve my patient’s adherence with their compliance and care coordination Very Satisfied	Rosemont helped improve my patient’s adherence with their compliance and care coordination Satisfied	Rosemont helped improve my patient’s adherence with their compliance and care coordination Somewhat Satisfied	Rosemont helped improve my patient’s adherence with their compliance and care coordination Neutral	Rosemont helped improve my patient’s adherence with their compliance and care coordination Somewhat Dissatisfied	Rosemont helped improve my patient’s adherence with their compliance and care coordination Dissatisfied	Rosemont helped improve my patient’s adherence with their compliance and care coordination N/A
Ability to reach a person by phone who could answer your question	Ability to reach a person by phone who could answer your question Very Satisfied	Ability to reach a person by phone who could answer your question Satisfied	Ability to reach a person by phone who could answer your question Somewhat Satisfied	Ability to reach a person by phone who could answer your question Neutral	Ability to reach a person by phone who could answer your question Somewhat Dissatisfied	Ability to reach a person by phone who could answer your question Dissatisfied	Ability to reach a person by phone who could answer your question N/A
Explanation of whom to call if there is an issue with your order	Explanation of whom to call if there is an issue with your order Very Satisfied	Explanation of whom to call if there is an issue with your order Satisfied	Explanation of whom to call if there is an issue with your order Somewhat Satisfied	Explanation of whom to call if there is an issue with your order Neutral	Explanation of whom to call if there is an issue with your order Somewhat Dissatisfied	Explanation of whom to call if there is an issue with your order Dissatisfied	Explanation of whom to call if there is an issue with your order N/A

Very Satisfied

Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Dissatisfied

N/A

The staff was courteous and helpful

The staff was courteous and helpful Very Satisfied

The staff was courteous and helpful Satisfied

The staff was courteous and helpful Somewhat Satisfied

The staff was courteous and helpful Neutral

The staff was courteous and helpful Somewhat Dissatisfied

The staff was courteous and helpful Dissatisfied

The staff was courteous and helpful N/A

I would recommend Rosemont to other physicians

I would recommend Rosemont to other physicians Very Satisfied

I would recommend Rosemont to other physicians Satisfied

I would recommend Rosemont to other physicians Somewhat Satisfied

I would recommend Rosemont to other physicians Neutral

I would recommend Rosemont to other physicians Somewhat Dissatisfied

I would recommend Rosemont to other physicians Dissatisfied

I would recommend Rosemont to other physicians N/A

The services provided met my needs and expectations

The services provided met my needs and expectations Very Satisfied

The services provided met my needs and expectations Satisfied

The services provided met my needs and expectations Somewhat Satisfied

The services provided met my needs and expectations Neutral

The services provided met my needs and expectations Somewhat Dissatisfied

The services provided met my needs and expectations Dissatisfied

The services provided met my needs and expectations N/A

Rosemont is easier to use then other pharmacies

Rosemont is easier to use then other pharmacies Very Satisfied

Rosemont is easier to use then other pharmacies Satisfied

Rosemont is easier to use then other pharmacies Somewhat Satisfied

Rosemont is easier to use then other pharmacies Neutral

Rosemont is easier to use then other pharmacies Somewhat Dissatisfied

Rosemont is easier to use then other pharmacies Dissatisfied

Rosemont is easier to use then other pharmacies N/A

Rosemont helped improve my patient’s adherence with their compliance and care coordination

Rosemont helped improve my patient’s adherence with their compliance and care coordination Very Satisfied

Rosemont helped improve my patient’s adherence with their compliance and care coordination Satisfied

Rosemont helped improve my patient’s adherence with their compliance and care coordination Somewhat Satisfied

Rosemont helped improve my patient’s adherence with their compliance and care coordination Neutral

Rosemont helped improve my patient’s adherence with their compliance and care coordination Somewhat Dissatisfied

Rosemont helped improve my patient’s adherence with their compliance and care coordination Dissatisfied

Rosemont helped improve my patient’s adherence with their compliance and care coordination N/A

Ability to reach a person by phone who could answer your question

Ability to reach a person by phone who could answer your question Very Satisfied

Ability to reach a person by phone who could answer your question Satisfied

Ability to reach a person by phone who could answer your question Somewhat Satisfied

Ability to reach a person by phone who could answer your question Neutral

Ability to reach a person by phone who could answer your question Somewhat Dissatisfied

Ability to reach a person by phone who could answer your question Dissatisfied

Ability to reach a person by phone who could answer your question N/A

Explanation of whom to call if there is an issue with your order

Explanation of whom to call if there is an issue with your order Very Satisfied

Explanation of whom to call if there is an issue with your order Satisfied

Explanation of whom to call if there is an issue with your order Somewhat Satisfied

Explanation of whom to call if there is an issue with your order Neutral

Explanation of whom to call if there is an issue with your order Somewhat Dissatisfied

Explanation of whom to call if there is an issue with your order Dissatisfied

Explanation of whom to call if there is an issue with your order N/A

Physician Satisfaction Survey

Question Title

1. How would you rate your level of satisfaction with the following?

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2. How can we improve our services?

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3. Comments:

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4. Signature (Optional)