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Prescription refill survey template

Make refills easy to get, from the request to the pickup

Four questions for after a refill is picked up or delivered: how easy it was to request, how long it took to be ready, how the patient got it and anything that went wrong. Use it as it is or change any question, and Usertick reads every written answer for you.

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What this prescription refill survey tells you

A prescription refill survey measures the routine part of pharmacy and practice work that patients repeat month after month: asking for the refill, waiting for it and getting it into their hands. This template asks four questions in about a minute and never asks which medicine the refill was for.

It is written for the days after the refill reaches the patient, sent by Usertick email to the patients whose refills went out that week or as a link in your own pickup or delivery message. A QR code on the bag or the delivery slip reaches patients who aren't on your contact list.

Results shows the request ease score with the share who found it easy, and the share of each turnaround band and each way of getting the refill. Every written answer to the last question is read as it arrives and filed under a category such as app and online access or waiting times, with a type and an urgency.

In an emailAs a linkOn your websiteAs a conversation
Questions
4
Time to answer
About a minute
Written for
After the refill is picked up or delivered, by email or a QR code
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, with the first question inside the email. A tap on an answer opens the rest of the survey with that answer already kept. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 4 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 4 · Customer effort

How easy was it to request your refill?

Why ask it
Patients request refills through a portal, a phone line or the pharmacy counter, and each route can add friction. A 1 to 7 effort scale shows how much work the request took.
What you learn
The average on the 1 to 7 scale and the share who found it easy, with a hard-to-easy bar, against the period before.
Make it yours
To compare request routes, add a question that asks how the patient requested the refill, then select each answer to see its ease score.
Question 2 of 4 · Multiple choice

How long did it take to be ready?

Why ask it
A refill that isn't ready when the patient arrives means a second trip or a gap in supply. Bands from the same day to more than five days make the answer quick.
What you learn
A donut with the share and count of each band, and the stacked shares over time, so a slower month shows up as a growing share of the longer bands.
Make it yours
Set the bands around the turnaround you promise, such as ready in two business days, so the share outside it is easy to read.
Question 3 of 4 · Multiple choice

How did you get it?

Why ask it
The way a patient gets the refill changes what can go wrong, from a line at the counter to a parcel left at the door. The answer lets you compare the experience by route.
What you learn
A donut with the share and count of each route. Select Home delivery to narrow the page to those patients and read what went wrong for them.
Make it yours
Add your own routes, such as a pickup locker or a drive-through window, so each one gets its own share.
Question 4 of 4 · Text · Optional

Did anything go wrong?

Why ask it
The open question asks directly about problems, which brings out the specific failure: a request that never arrived, a delivery that missed, a refill that needed a new approval.
What you learn
Each answer with its sentiment and theme, filterable by theme, with up to 8 themes and their trends. Usertick also marks each one as a bug, a complaint or a question and flags the urgent ones, such as a delivery that never came.
Make it yours
Use the placeholder to ask patients to describe the problem without naming their medicine.

What the answers show

Results turns each question into numbers you can follow week by week.

How easy was it to request your refill?

The average on its own scale and the share who found it easy, against the period before and by device.

How long did it take to be ready?

The share of each answer with its count. Select an answer to narrow the whole page to those people and read what else they said.

How did you get it?

The share of each answer with its count. Select an answer to narrow the whole page to those people and read what else they said.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Prescription refill in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Send it after the refill arrives

    Usertick doesn't get an event from your pharmacy system, so send each week's refills on a schedule or put the link in your own pickup and delivery messages.

  2. 02

    Decide how often to ask

    Skip people who already received this survey is on by default, so each patient hears from you once. Turn it off to ask about later refills too.

  3. 03

    Route urgent answers fast

    On every plan, a workflow can post every response that becomes urgent to Slack or Microsoft Teams, so the pharmacy team calls the patient the same day.

  4. 04

    Keep medicine names out

    Ask about the request, the wait and the pickup, never the medicine. Usertick's terms don't allow medical details in surveys, and Usertick doesn't sign business associate agreements.

Customer effort scorePatient satisfaction surveysEmail surveysPharmacy and prescriptions questions

More customer effort templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

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Customer effortTelehealth visitFind out how easy it was to join a video visit and whether patients would choose one again. Send it right after the call ends.
Customer effortPatient portalMeasure how easy your patient portal is to use and whether people could finish what they came to do. Show it after a patient logs out.
Customer effortLab testMeasure the lab experience from booking to results, including waits at the lab. Send it once results are released.
Customer effortVaccination clinicLearn how easy it was to get an appointment, how long people waited and whether aftercare information was clear. Send it the day after the appointment.

Questions from the library

Browse the question library
  1. How would you rate the pharmacy visit?Stars · Pharmacy and prescriptions
  2. How many minutes did you wait?Ruler · Pharmacy and prescriptions
  3. Did you get everything on your prescription?Yes / No · Pharmacy and prescriptions
  4. How easy was it to book your eye exam?Customer effort · Eye care
  5. How well was the test explained as it went along?Stars · Eye care
  6. How long since your last eye exam?Dropdown · Eye care

Frequently asked questions

Once the refill has reached the patient, so they can rate the whole process. Usertick sends email now or at a time you schedule up to 30 days ahead, and it doesn't send on its own when a refill is picked up.

Four is enough for a routine task. This template asks four and takes about a minute.

Yes. Print the survey's QR code on the bag or the delivery slip, and it opens the hosted survey page in the patient's phone browser.

Select Home delivery to see those patients' answers, give each problem an owner in the inbox, and share the pattern with your delivery partner.

Ask them not to. Usertick's terms don't allow medical details in surveys and Usertick doesn't sign business associate agreements, so the placeholder of the open question can ask patients to describe the problem without the medicine.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

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