This feedback template includes 7 fields. Gather patient feedback on pharmacy services including wait times, staff knowledge, and prescription accuracy. Free to customize and use on ZenBuild.
Your Name (text, optional)
What service did you use? (dropdown selection, required) — options: Prescription pickup, New prescription drop-off, Consultation with pharmacist, Vaccination/immunization, Over-the-counter purchase, Insurance/billing question
How would you rate the wait time? (rating, required)
How knowledgeable and helpful was the pharmacy staff? (rating, required)
Was your prescription filled accurately? (multiple choice, required) — options: Yes, No, Not applicable
Did the pharmacist explain medication instructions clearly? (multiple choice, required) — options: Yes, very clearly, Somewhat, No explanation provided, Not applicable
Any additional comments or concerns? (long text, optional)
