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Survey Template15 questions~5-7 minutes

Patient Satisfaction Survey Template: Healthcare Experience Feedback

Patient satisfaction surveys help healthcare providers measure and improve the patient experience across care touchpoints.

Use This Template
15
Questions
5-7 minutes
To Complete
4
Closed Questions
1
Open Questions

Sample Questions Included

1
Multiple ChoiceOverall satisfaction

How would you rate your overall experience?

Very PoorPoorAverageGoodExcellent
2
Multiple ChoiceScheduling experience

How easy was it to schedule your appointment?

Very DifficultDifficultNeutralEasyVery Easy
3
Multiple ChoiceCommunication effectiveness

Did your care provider explain things clearly?

Not at allSomewhatMostlyCompletely
4
Multiple ChoiceHealthcare NPS

How likely to recommend this facility? (0-10)

012345678910
5
Open-EndedImprovement feedback

What could we do to improve your experience?

When to Use This Template

Hospital satisfaction
Clinic feedback
Telehealth evaluation
Specialist visits

Best Practices

  • 1.Comply with HIPAA
  • 2.Send surveys promptly after visit
  • 3.Make accessible (language, format)

Industries Using This Template

HealthcareHospitalsClinicsDentalMental Health
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Frequently Asked Questions

This template is inspired by HCAHPS but isn't official. For official HCAHPS, work with an approved vendor.

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