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Patient Satisfaction Survey Template

A Patient Satisfaction Survey is a general term for questionnaires used across various medical settings (hospitals, clinics, physician offices) to measure patient experience, quality of care, and overall satisfaction with medical services received.

Our Patient Satisfaction Survey template helps you measure patient satisfaction quickly, with 11 questions (including 7 within a carousel) helping you get an overview of the patient experience. Get an overall satisfaction rating from 0-5, plus feedback on topics such as the quality of care given, the knowledge and helpfulness of healthcare provider, ease of scheduling appointments, wait times, and more. Includes open-ended questions for additional comments plus

Key Benefits

The data collected from these surveys is crucial for both clinical and administrative improvement:

  • Improves Quality of Patient Care
  • Enhances Doctor-Patient Communication
  • Measures Compliance with Best Practices
  • Optimizes Resource Allocation
  • Increases Patient Safety and Trust
Use this template
Number of questions:
11

Questions used in this template

Patient Satisfaction Survey

Thank you for taking the time to complete this survey. Your feedback is important to us as we strive to improve the quality of care we provide.

The results of this survey will be used to identify areas for improvement and to ensure that we are meeting the needs of our patients.

Tell Us How We Did

Rate the following on a scale of ‘Very poor’ to ‘Very good’…

Q1. The quality of care you received

  1. Very poor
  2. Poor
  3. OK
  4. Good
  5. Very good

Q2. The knowledge and expertise of the healthcare professionals who provided your care

  1. Very poor
  2. Poor
  3. OK
  4. Good
  5. Very good

Q3. How easy was it to schedule appointments

  1. Very poor
  2. Poor
  3. OK
  4. Good
  5. Very good

Q4. The wait times for appointments

  1. Very poor
  2. Poor
  3. OK
  4. Good
  5. Very good

Q5. The clarity and helpfulness of communication from our healthcare professionals

  1. Very poor
  2. Poor
  3. OK
  4. Good
  5. Very good

Q6. The availability of information about your condition and treatment

  1. Very poor
  2. Poor
  3. OK
  4. Good
  5. Very good

Q7. Convenience of the location of the healthcare facility

    1. Very poor
    2. Poor
    3. OK
    4. Good
    5. Very good

Tell Us How We Did

Q8. Overall, on a scale of 1 to 5, how was your experience of our service?

(1 = Extremely poor     5 = Very good)

  1. 1
  2. 2
  3. 3
  4. 4
  5. 5

Q9. If you have any comments, please record them in the space below:

About Yourself

Q10.  How old are you?

  1. Under 18
  2. 18 – 24
  3. 25 – 34
  4. 35 – 44
  5. 45 – 54
  6. 55 – 64
  7. 65 +

Q11. What gender do you identify as?

  1. Male
  2. Female
  3. Transgender
  4. Non-binary
  5. I describe myself in another way (please specify) _________________________
  6. Prefer not to answer

Thank you for your time