External Validation Tool
Consumer Services Tool
Name of the Pharmacy Locality
Consumer Number Date Time
We would be very grateful if you could spare some of your time so that we can
interview you to complete this tool. All the responses you will give will be treated in
strictest confidence and will be analysed together with all the other completed
questionnaires. Thank you in anticipation.
Approximately how often do you go to a community pharmacy?
Please tick one
at least once a week
2-3 times a month
once a month
less often
1. When you need to go to a pharmacy do you come to this pharmacy?
Please tick one
always
10
frequently
8
rarely
5
2. How satisfied are you with the services offered by this community pharmacy?
Please tick one
very satisfied
10
fairly satisfied
8
neither satisfied nor dissatisfied
5
not very satisfied
3
not satisfied
1
3. How do you rate the pharmacy on the following factors?
the cleanliness of the
Very Poor
Fairly Poor
Fairly Good
Very Good
0
1
3
4
0
1
3
4
0
1
3
4
0
1
3
4
0
1
3
4
0
1
3
4
pharmacy
the comfort and
convenience of the
waiting areas
having in stock the
medicines/appliances
you need
offering a clear and
well organised layout
how long you have to
wait to be served
having somewhere
available where you
could speak to the
pharmacist in private
without being
overheard
4. How satisfied are you with the following characteristics of the pharmacist?
(Please tick each characteristic)
Please give an answer for each one
Very
Fairly
Neither
Not very
satisfied
satisfied
satisfied
satisfied
Not satisfied
nor
dissatisfied
4
3
2
1
0
helpfulness of the staff 4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
greeting by
pharmacist
The privacy of your
conversations with the
pharmacist
politeness and
professionalism of the
staff
efficiency with which
the
pharmacist deals with
your request
the pharmacist’s
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
professional
relationship with you
the advice given by
the
pharmacist when
dispensing a medicine
The pharmacist’s
instructions about how
to take your
medications
the written information
the pharmacist
provides you about
drug therapy and/or
diseases
questions asked by
the
pharmacist before
dispensing an
overthecounter medicine
how well the
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
pharmacist explains
what your medication
is and how it works
the advice the
pharmacist gives you
about proper storage
of your medication
how well the
pharmacist explains
possible side effects
How well the
pharmacist works with
your doctor to make
sure your medications
are the best for you
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
the amount of time the 4
3
2
1
0
3
2
1
0
the pharmacist’s
interest in your health
the advice given by
the pharmacist on a
current health problem
or a longer term
health condition
providing general
advice on leading a
more healthy lifestyle
how well the
pharmacist answers
your questions
pharmacist offers to
spend with you
language used by the
pharmacist (i.e. simple
or complicated)
4
disposing of
4
3
2
1
0
4
3
2
1
0
medicines you no
longer need
providing advice on
health services or
information available
elsewhere
5. Could you please rate the importance of the following factors?
Please give an answer for each one
Very
Fairly
Neither
Fairly
Very
Important
Important
Important
unimportant
unimportant
Nor
unimportant
longer
4
3
2
1
0
4
3
2
1
0
opening
hours of the
pharmacy
pharmacist is
accessible
even
when the
pharmacy
is closed
the
4
3
2
1
0
4
3
2
1
0
4
3
2
1
0
pharmacist
handles
complaints
efficiently
having an
area in the
pharmacy to
speak to the
pharmacist in
privacy
diagnostic &
monitoring
services such
as
urine testing,
cholesterol,
blood sugar
measuremen
t and blood
pressure
monitoring
keeping
4
3
2
1
0
patient
medication
records by
the
pharmacist.
6. How satisfied are you with the quality of advice you receive from the pharmacist?
Please tick one
very satisfied -10
fairly satisfied -8
neither satisfied nor disatisfied -5
not very satisfied -4
not at all satisfied -1
7. Have you ever been given advice about any of the following by the pharmacist or
pharmacy staff?
Yes
No
Stopping smoking
4
0
Healthy eating
4
0
Physical exercise
4
0
8. How likely are you to:
Please give an answer for each one
go to a
Highly Likely
Fairly likely
Don’t know
Not likely
4
3
2
0
4
3
2
0
pharmacist first
when you feel
a symptom
confirm with
your
pharmacist
the use of
over-thecounter
medicines
follow the
4
3
2
0
advice given by
the
pharmacist
9. Which of the following best describes how you use this pharmacy?
This is the pharmacy that you choose to visit if possible
10
This is one of several pharmacies that you use when you need to
5
This pharmacy was just convenient for you today
2
Remarks
Total Grade