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* 1. Do you or your family use local pharmacy services?

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* 2. Which pharmacy do you typically visit?

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* 3. How do you typically travel to the pharmacy?

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* 4. How long does it take to travel to your usual pharmacy?

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* 5. How important do you think it is that every community has access to a local pharmacy?

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* 6. Is there anything that has stopped you using a pharmacy or chemist when you need to?

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* 7. Overall, how satisfied re you with the service provided when visiting your local pharmacy?

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* 8. How old are you?

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* 9. In order to see if service requirements vary by age, please indicate the approximate age of the oldest person in your household?

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* 10. Please share any other views in relation to local pharmacy provision here:

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* 11. To provide a better geographical understanding of this survey data, what are the first 5 characters of your postcode?

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* 12. To ensure every survey is unique, what is your first name?

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* 13. What is your last name?

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* 14. What is your email address? I will contact you about the results of this survey and other related matters.

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