Name (optional):_________________________________ Age: ____

Please fill out the requested information by placing (/) checkmark inside the bracket.

Gender : [ ] male [ ] female

[ ] employee [ ] unemployed [ ] senior citizen [ ] Physically disabled

Objective: To find out the convenience of a customer in buying medicines.

1. How often do you visit the pharmacy?

[ ] 1-2 times a week

[ ] 3-4 times a week

[ ] 1-2 times a month

[ ] 3-4 times a month

2. How satisfied were you in going to the pharmacy to buy medicines?

[ ] very satisfied

[ ] satisfied

[ ] fairly satisfied

[ ] not satisfied

[ ] not at all satisfied

3. How satisfied are you with the time it took for the pharmacy to provide the medicines you

need?

[ ] very satisfied

[ ] satisfied

[ ] fairly satisfied

[ ] not satisfied

[ ] not at all satisfied

4. How satisfied are you in the availability of medicines in the pharmacy?

[ ] very satisfied

[ ] satisfied

[ ] fairly satisfied

[ ] not satisfied

[ ] not at all satisfied

5. What do you prefer in buying medicines?

[ ] direct transactions in the pharmacy

[ ] online and pick up transactions

[ ] online delivery transactions