Website Customer Satisfaction Survey

1
Name* This field is required.
First Name
Last Name
2
Are you a Patient or a Prescriber* This field is required.
Patient
Prescriber
3
NPI* This field is required.
4
Date of Birth
Date of Birth
Month
Day
Year
5
State of Residency
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
6
Professionalism
Very Poor
Poor
Fair
Good
Very Good
1. How would you rate the professionalism of our staff?
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1. How would you rate the professionalism of our staff?
Very Poor
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Poor
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Fair
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Good
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Very Good
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Accuracy
Very Poor
Poor
Fair
Good
Very Good
2. How would you rate the accuracy of the medication and supplies we gave or sent you?
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2. How would you rate the accuracy of the medication and supplies we gave or sent you?
Very Poor
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Poor
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Fair
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Good
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Very Good
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8
Contact
Very Poor
Poor
Fair
Good
Very Good
3. Rate how easy it is to get in touch with us by phone?
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4. Rate how easy it is to get answers to your questions, follow-up, or help with any concerns you have?
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3. Rate how easy it is to get in touch with us by phone?
4. Rate how easy it is to get answers to your questions, follow-up, or help with any concerns you have?
Very Poor
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Poor
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Fair
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Good
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Very Good
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Very Poor
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Poor
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Fair
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Good
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Very Good
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Timeliness
Very Poor
Poor
Fair
Good
Very Good
5. How would you rate the timeliness of scheduling and receiving your medications?
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5. How would you rate the timeliness of scheduling and receiving your medications?
Very Poor
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Poor
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Fair
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Good
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Very Good
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10
Overall Experience
Very Poor
Poor
Fair
Good
Very Good
6. How would you rate your overall experience with HSP?
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6. How would you rate your overall experience with HSP?
Very Poor
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Poor
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Fair
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Good
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Very Good
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11
Professionalism.
Very Poor
Poor
Fair
Good
Very Good
1. How would you rate the professionalism of our staff?
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1. How would you rate the professionalism of our staff?
Very Poor
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Poor
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Fair
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Good
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Very Good
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12
Contact.
Very Poor
Poor
Fair
Good
Very Good
2. How would you rate the responsiveness of our staff?
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3. How would you rate the ability to reach a person by phone?
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4. How would you rate the ability to send HSP a prescription
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2. How would you rate the responsiveness of our staff?
3. How would you rate the ability to reach a person by phone?
4. How would you rate the ability to send HSP a prescription
Very Poor
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Poor
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Fair
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Good
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Very Good
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Very Poor
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Poor
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Fair
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Good
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Very Good
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Very Poor
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Poor
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Fair
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Good
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Very Good
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Overall Experience.
Very Poor
Poor
Fair
Good
Very Good
5. How would you rate your overall experience with HSP?
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5. How would you rate your overall experience with HSP?
Very Poor
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Poor
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Fair
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Good
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Very Good
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14
Review CommentUse this space to express in your own words your review of Highland Specialty Pharmacy and offer suggestions you may have to improve our services.
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