Online Survey | Built with Qualtrics Experience Management™

UCLA Specialty Pharmacy
200 Medical Plaza

Please select the purpose of your most recent call (multiple ok)

Please rate the following regarding your most recent call to our specialty pharmacy

Please rate the following regarding your most recent call to our specialty pharmacy
	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Your call was answered promptly	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Our staff communicated clearly and concisely	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Your ability to get prescription refills	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
The professionalism of our staff	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Availability of the on-call pharmacist	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply

Please rate the following areas for our patient management program

Please rate the following areas for our patient management program
	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
The helpfulness of the person who took your call	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Taking time to answer your questions thoroughly	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Instructions regarding your medication	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Empathy and concern for your needs	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Respect for your privacy	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Knowledge of your health condition	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Knowledge of your medication(s)	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply

Your prescription

Your prescription
	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Helpfulness of those helping you with billing and insurance issues	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Timeliness of your prescription delivery	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Condition of the prescription when received	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Keeping you informed of your prescription status	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply

Your overall statisfaction

Your overall statisfaction
	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Our pharmacy	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Our service	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply
Your experience with our specialty pharmacy over others you've used	Excellent	Very Good	Average	Below Average	Poor	Does Not Apply

Please rate the following areas in regards to your quality of life

Please rate the following areas in regards to your quality of life
	Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
In recent interactions with our pharmacy, has positive progress been made towards your health care, related to discussions with our pharmacist?	Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
In the past week have you felt overwhelmed with your health, related to discussions with our pharmacist?	Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
In the past week have you felt your therapy is working for you?	Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree

Would you use our pharmacy again?