Please indicate the practice/cancer center where you receive your cancer care.
This will make sure your feedback is recorded to the correct location.
* Your Practice/Cancer Center:
1. Where do you get your oncology medication(s)?
    • 2. Are you required to use a mail-order pharmacy or have your medications filled outside of the pharmacy in the     doctor's office?
    • 3. If yes, explain why?
    • 4. Convenience of receiving prescriptions from the pharmacy that filled your prescription
    • 5. Time involved to receive prescriptions from the pharmacy that filled your prescription
    • 6. Your interaction with the staff at the pharmacy that filled your prescription
    • 7. General satisfaction with the pharmacy that filled your prescription
    • 8. Has the pharmacy that filled your prescription helped you with any co-pay/foundation assistance?
    • 9. If yes, how satisfied are you with the assistance you received from the pharmacy?
    • 10. Where would you prefer to fill your oncology medications?
    • 11. Please add additional comments or explanations to previous question(s)
    • 12. Gender
    • 13. Zip Code
    14. Would you like someone from our practice pharmacy to contact you? If so, please use the comment box in      #11 to include reasons for call.
    • 15. Your Last Name
    16. Your First Name
    17. Phone
    The Patient Pharmacy Satisfaction Survey was created by the Community Benchmarks Program at Syracuse University in conjunction with National Community Oncology Dispensing Association (NCODA). NCODA and Community Oncology Pharmacy Association (COPA) collaborating together with slight modifications to original survey to help improve patient care through utilization of electronic patient survey.