External Validation Tool
VALIDATION OF COMMUNITY PHARMACY
Consumer Services Tool
Name of the Pharmacy
Consumer Number
Locality
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
1
External Validation Tool
2.
How satisfied are you with the services offered by this community pharmacy?
Please tick one
3.
very satisfied
10
fairly satisfied
8
neither satisfied nor dissatisfied
6
not very satisfied
4
not satisfied
1
Considering the service from this community pharmacy how satisfied are you with
each of the following aspects of their service?
Very
Satisfied
Fairly
Satisfied
greeting by pharmacist
4
3
2
1
0
helpfulness of the staff
4
3
2
1
0
privacy
4
3
2
1
0
politeness of the staff
4
3
2
1
0
efficiency with which
pharmacist dealt
with your request
4
3
2
1
0
Very
Satisfied
Fairly
Satisfied
Please give an answer for each one
4.
Neither satisfied
Nor Dissatisfied
Not
very satisfied
Not
satisfied
How do you feel about:
Please give an answer for each one
the advice given by the
pharmacist when
dispensing a medicine
the written information
provided on how to
take your medication
questions asked by the
pharmacist before
dispensing an overthe-counter medicine
having to buy over-thecounter medicines
only from a pharmacy
the set-up of the
pharmacy
Neither satisfied
Nor Dissatisfied
Not
very satisfied
Not
satisfied
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
2
External Validation Tool
5.
Could you please rate the importance of the following factors?
Please give an answer for each one
opening hours of the
pharmacy
pharmacist is
accessible even
when the pharmacy
is closed
the pharmacist handling
complaints
efficiently
having an area in the
pharmacy to speak
to the pharmacist in
privacy
diagnostic & monitoring
services such as
urine testing
6.
Very
Important
Fairly
Important
Neither important
Nor unimportant
Fairly
Very
unimportant
unimportant
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
How satisfied are you with the quality of advice you receive from the pharmacist?
Please tick one
very satisfied
10
fairly satisfied
8
satisfied
6
not very satisfied
4
not at all satisfied
1
3
External Validation Tool
7.
How likely are you to:
Please give an answer for each one
go to a pharmacist first
when you feel a symptom
confirm with your pharmacist
the use of over-the-counter
medicines
follow the advice given by the
pharmacist
Highly Likely
Fairly Likely
Don’t Know
Not Likely
4
3
2
0
3
2
1
0
3
2
1
0
Remarks
LEAVE BLANK
For compilation of results
Total Grade
4