Question Title

* 1. Q1. Why did you visit this pharmacy today?
To collect a prescription for:

If you did not collect a prescription, please go to Q3.

Question Title

* 2. Q2 If you collected a prescription today, were you able to collect it straight away, did you have to wait in the pharmacy or did you come back later to collect it?

Question Title

* 3. Q3 How satisfied were you with the time it took to provide your prescription and/or any other NHS services you required?

Please tick one box for each aspect of the pharmacy listed below, to show how good or poor you think it is:

Question Title

* 4. Q4 Thinking about previous visits as well as today's, how would you rate the pharmacy on the following factors?

  Very poor Fairly poor Fairly good Very good Don't know
a) Cleanliness of the pharmacy
b) The comfort and convenience of the waiting areas (e.g. seating or standing room)
c) Having in stock the medicines/appliances you need
d) Offering a clear and well organised layout
e) How long you have to wait to be served
f) Having somewhere available where you could speak without being overheard, if you wanted to
Please tick one box for each aspect of the service listed below, to show how good or poor you think it is:

Question Title

* 5. Q5 Again, including any previous visits to this pharmacy, how would you rate the pharmacist and other staff who work there?

  Very poor Fairly poor Fairly good Very good Don't know
a) Being polite and taking the time to listen to what you want
b) Answering any queries you may have
c) The service you received from the pharmacist
d) The service you received from the other pharmacy staff
e) Providing an efficient service
f) The staff overall
Please tick one box for each aspect of the service listed below, to show how good or poor you think it is:

Question Title

* 6. Q6 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
a) Providing advice on a current health problem or a longer term health condition
b) Providing general advice on leading a more healthy lifestyle
c) Disposing of medicines you no longer need
d) Providing advice on health services or information available elsewhere

Question Title

* 7. Q7 Have you ever been given advice about any of the following by the pharmacist or pharmacy staff?

  Yes No
Stop smoking
Healthy eating
Physical exercise

Question Title

* 8. Q8 Which of the following best describes how you use this pharmacy?

Question Title

* 9. Please answer yes or no to the following

  Yes No
Q9 Are you aware the Weldrick Pharmacies have a delivery service?
If No, would you have used the service if you had known it existed?
Q10 Are you aware that Weldrick Pharmacies have a website with health information and an online store?
If No, would you have used the service if you had known it existed?
*Q11 Are you aware that Weldricks Pharmacies have a Prescription Ordering Service? *Not available in some areas.
If No, would you have used the service if you had known it existed?
Q12 Have you been asked to nominate Weldricks for your electronic prescription?
Q13 Would you recommend Weldricks Pharmacies to someone who has a prescription or needs Pharmacy services?
Q14 Are you aware of the fact that Weldricks Pharmacy is a local, Independently run family business?
These last few questions are just to help us categorise your answers

Question Title

* 10. Q15 How old are you?

Question Title

* 11. Q16 Are you...

Question Title

* 12. Q17 Which of the following apply to you?

Question Title

* 13. Q18 Finally, taking everything into account -the staff, the shop and the pharmacy- how would you rate the pharmacy where this questionnaire?

Question Title

* 14. Q19 If you have any comments about how the service from this pharmacy could be improved, please write them in here:

Question Title

* 15. Which store did you visit

  Tick box
Armthorpe The Parade (13 THE PARADE, CHURCH STREET, ARMTHORPE. DN3 3AG) 150
Armthorpe White House Farm 1(WHITE HOUSE FARM MEDICAL CENTRE, CHURCH ST, ARMTHORPE DN3 3AH) 150
Barnburgh (4 HIGH STREET, BARNBURGH, DONCASTER DN5 7EP) 100
Barnby Dun (MARLOWE ROAD, BARNBY DUN, DONCASTER DN3 1AX) 100
Bawtry (36 HIGH STREET, BAWTRY . DN10 6JE) 125
Beckett Rd (61- 63 BECKETT ROAD, WHEATLEY. DN2 4AD) 100
Bolton (ST ANDREWS SQUARE, BOLTON ON DEARNE. S63 8BA) 150
Brinsworth (27 BRINSWORTH LANE, ROTHERHAM. S60 5BS) 150
Cantley Everingham Rd (8 EVERINGHAM ROAD, CANTLEY. DN4 6JG) 125
Cantley Goodison Boulevard (THE BURNS PRACTICE, GOODISON BOULEVARD, CANTLEY. DN4 6NJ)150
Cantley St Wilfrids Court (ST WILFRIDS COURT, CANTLEY. DN4 6ED) 125
Carcroft (14 HIGH STREET, CARCROFT, DONCASTER. DN6 8DP) 125
Catcliffe (26 MAIN STREET, CATCLIFFE, ROTHERHAM. S60 5SR) 100
Conisbrough Church St (44 CHURCH STREET, CONISBROUGH. DN12 3HR) 100
Conisbrough Gardens Lane (STONECASTLE CTR., GARDENS LN, CONISBROUGH. DN12 3JW)  150
Crowle (MARKET PLACE, CROWLE, SCUNTHORPE DN17 4LB) 150
Darnall Main Rd (171 MAIN ROAD, DARNALL, SHEFFIELD. S9 5HP) 125
Darnall PCC (DARNALL PRIMARY CARE CENTRE, MAIN ROAD, DARNALL, SHEFF S9 4QH) 150
Denaby (DENABY SPRINGWELL CTR, CHURCH RD, DENABY MAIN, DONC DN12 4AB) 125
Dunscroft (THE ABBEY SHOPPING CENTRE, STATION ROAD, DUNSCROFT, DONC DN7 4JS) 100
East Laith Gate (40-42 EAST LAITH GATE. DN1 1HZ) 125
Edenthorpe (122 THORNE ROAD, EDENTHORPE. DN3 2JA) 100
Edlington Martinwells Centre (THE MARTINWELLS CENTRE, THOMPSON AVENUE, EDLINGTON DN12 1JD) 150
Epworth (5 HURCH STREET, EPWORTH, N LINCOLNSHIRE DN9 1ER) 150
Goldthorpe Barnsley Rd (26-28 BARNSLEY ROAD, GOLDTHORPE S63 9NF) 125
Goldthorpe Centre (THE GOLDTHORPE CENTRE, GOLDTHORPE GREEN, GOLD. S63 9EH) 150
Harworth (67 SCROOBY ROAD, HARWORTH, DONCASTER DN11 8JN) 75
Hatfield (THE HEATHFIELD CENTRE, ASH HILL ROAD, HATFIELD. DN7 6JH) 150
Haxey (30 CHURCH STREET, HAXEY, DONCASTER DN9 2HY) 150
Intake (81 SANDRINGHAM ROAD, INTAKE DN2 5JA) 100
Kirk Sandall (54 BRECKS LANE, KIRK SANDALL, DONCASTER DN3 1JR) 125
Leedale Internet (LEEDALE HOUSE, RAILWAY COURT, DONCASTER DN4 5FB) 150
Lodgemoor (66 ROCHESTER ROAD, LODGE MOOR, SHEFFIELD S10 4JQ) 125
Maltby High Street (94A HIGH STREET, MALTBY.  S66 7BN) 125
Maltby Laburnum Parade (3 LABURNUM PARADE, MALTBY, ROTHERHAM S66 8DP) 100
Maltby Services Centre (MALTBY SERVICES CENTRE, BRAITHWELL ROAD, MALTBY. S66 8JE) 150
Misterton (THE RETORT HOUSE, MARSH LANE, MISTERTON, DONCASTER DN10 4DL)150
Moorends (THE ORCHARD CENTRE, MARSHLANDS ROAD, MOORENDS. DN8 4SB) 150
Owlthorpe (1 MOORTHORPE BANK, OWLTHORPE, SHEFFIELD S20 6PD) 125
Rossington (35 GRANGE LANE, ROSSINGTON. DN11 0LW) 150
Royston High Street (48A HIGH STREET, ROYSTON. S71 4RF) 125
Royston Midland Road (65C MIDLAND ROAD, ROYSTON. S71 4QW) 150
Scawthorpe (100 AMERSALL ROAD, SCAWTHORPE, DONCASTER. DN5 9PH) 150
SCUNTHORPE IRONSTONE CTR (WEST STREET, SCUNTHORPE. DN15 6HX) 150
Scunthorpe Frodingham Road, ( WEST STREET, SCUNTHORPE, N Lincs DN15 7NJ) 125
Skellow (221 (Unit 4) SKELLOW ROAD, SKELLOW, DONCASTER. DN6 8JH) 75
Sothall (26 ECKINGTON ROAD, SOTHALL, SHEFFIELD S20 1HQ) 150
Sprotbrough Road (235 SPROTBROUGH ROAD, DN5 8BP) 125
Stainforth Field Rd (FIELD ROAD, STAINFORTH. DN7 5AF) 150
Swallownest (31/33 HIGH STREET, SWALLOWNEST, SHEFFIELD S26 4TT) 150
Swinton Church Street (1A – 3A CHURCH STREET, SWINTON, S64 8QA) 150
Swinton Crown St (17 CROWN STREET, SWINTON. S64 8NB) 150
The Flying Scotsman Centre (ST SEPULCHRE GATE WEST, DONCASTER DN1 3AP) 100
The Vermuyden Centre (FIELDSIDE, THORNE, DONCASTER DN8 4BQ)
THORNE FIELDSIDE (14 FIELDSIDE, THORNE.  DN8 4BQ) 125
THORNE FINKLE STREET (2 – 4 FINKLE STREET, THORNE.   DN8 5DE) 75
Thurnscoe Holly Bush Drive (THE THURNSCOE CENTRE, HOLLY BUSH DRIVE, THURNSCOE S63 0LT) 150
Wheatley (296 THORNE ROAD, WHEATLEY HILLS, DONCASTER DN2 5AJ) 100
Woodlands Princess St (2 PRINCESS STREET, WOODLANDS, DONCASTER DN6 7LX) 125
Woodlands Woodside View (WOODSIDE VIEW, THE CRESCENT, WOODLANDS, DONCASTER DN6 7JR) 100
Store 1
Store 2
Store 3
Store 4
Store 5

Question Title

* 16. Sign with your initials to complete

T