SHC Campus Pharmacy Survey

This is a survey created for our customers who use our campus pharmacy services. Customers include students, faculty, staff and other community members. We would like to identify who is utilizing our services, how they heard about us, gauge their satisfaction, as well as offer an opportunity for feedback and suggestions for improvement.

Question 1

Whom do we have the pleasure of serving? Please specify below:

Student
Faculty
Staff
Community participant

Question 2

How did you hear about our pharmacy services? (Check all that apply)

Flyer/poster
Walking by
Website
Email blast
Referral by friends/other students
Referral by faculty/staff
Orientation/Campus Event
Other (please specify)

Questions 3 - 6

Please indicate your level of satisfaction with the following:

	Very satisfied	Moderately satisfied	Neither satisfied nor dissatisfied	Moderately dissatisfied	Very dissatisfied
	5	4	3	2	1
Ease of getting your prescription(s) filled and/or purchase of over the counter (OTC) products.
Length of time spent waiting for services or getting your prescription filled.
Pharmacy staff's ability to answer your questions or concerns.
Your privacy was maintained during the process.

Question 7

Do you have any additional comments or suggestions regarding your visit to the Student Health /Campus Pharmacy?

Yes (please explain)
No

Question 8

If you were not completely satisfied with your service? Would you like one of our staff members to reach out to you? If so, please leave your name, student ID and phone number where you can be reached, below:

Name:
Student ID:
Phone number:

Question 9

If a medication delivery option were available, how likely are you to transfer your prescriptions from your current pharmacy to UH Campus Pharmacy?

Extremely likely
Very likely
Somewhat likely
Not so likely
Not at all likely