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 Template15
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
Frequently Asked Questions
This template is inspired by HCAHPS but isn't official. For official HCAHPS, work with an approved vendor.
Related Resources
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