Pharmacy Technician Feedback Form Satisfaction Questionnaire for your Pharmacy Technician Making you feel at ease, (being friendly and warm towards you, treating you with respect; not cold or abrupt) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Letting you tell “your” story… (giving you time to fully describe your illness in your own words; not interrupting or diverting you) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Really listening… (paying close attention to what you were saying; not looking at the notes or computer as you were talking) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Being interested in you as a whole person… (asking/knowing relevant details about your life, your situation; not treating you as “just a number”) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Fully understanding your concerns… (communicating that he/she had accurately understood your concerns; not overlooking or dismissing anything) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Showing care and compassion… (seeming genuinely concerned, connecting with you on a human level; not being indifferent or “detached”) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Being positive… (having a positive approach and a positive attitude; being honest but not negative about your problems) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Explaining things clearly… (fully answering your questions, explaining clearly, giving you adequate information; not being vague) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Helping you to take control… (exploring with you what you can do to improve your health yourself; encouraging rather than “lecturing” you) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Making a plan of action with you… (discussing the options, involving you in decisions as much as you want to be involved; not ignoring your views) Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Overall, how would you rate your consultation today? Poor to Fair Fair Fair to Good Good Very Good Excellent Outstanding Any other comments Submit