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Patient experience

Patient satisfaction survey template

Booking, wait time, communication, respect and overall experience of a visit. Collects no medical details.

7 questions · about 3 minutes to complete · free on every plan

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Free account required. The template is copied into your workspace; edit anything before publishing.

When to use it
Within 48 hours of the appointment.
Who it is for
Patients after a visit, anonymously.

How to use this template

  1. Send it within 48 hours of the visit; response rates and recall both fall the longer you wait.
  2. Ask about communication ('explained things in a way I understood') before overall satisfaction.
  3. Do not ask for diagnoses or medications in a general feedback survey.

Questions in the patient satisfaction survey template

  1. 1. How easy was it to book your appointment?

    rating

  2. 2. How long did you wait past your appointment time?

    single choice · Seen on time, Under 15 minutes, 15–30 minutes, 30–60 minutes, Over an hour

  3. 3. The person who treated you…

    matrix · Listened carefully, Explained things in a way I understood, Involved me in decisions about my care, Treated me with respect, Spent enough time with me

  4. 4. How would you rate the front-desk staff?

    rating

  5. 5. How clean and comfortable was the clinic?

    rating

  6. 6. How likely are you to recommend this practice to friends or family?

    nps

  7. 7. Is there anything we could do better?

    open text

What the results look like

IllustrativeSynthetic sample of 120 responses generated for this preview, not real survey data. Your results page shows the same charts for your own responses.

1.How easy was it to book your appointment?

120 answered
Average 3.5
Answer distribution
AnswerCountPercent
198%
21513%
33126%
43428%
53126%

2.How long did you wait past your appointment time?

120 answered
Answer distribution
AnswerCountPercent
Seen on time2319%
Under 15 minutes98%
15–30 minutes3731%
30–60 minutes2017%
Over an hour3126%

3.The person who treated you…

120 answered
StatementStrongly disagreeDisagreeNeutralAgreeStrongly agreen
Listened carefully12%18%14%27%30%120
Explained things in a way I understood10%11%28%25%27%120
Involved me in decisions about my care8%12%23%28%30%120
Treated me with respect10%16%13%30%31%120
Spent enough time with me6%13%23%23%36%120

4.How would you rate the front-desk staff?

120 answered
Average 3.7
Answer distribution
AnswerCountPercent
11210%
21210%
32017%
43630%
54033%

How to read these questions

  • rating: Report the mean and the top-two-box share (the two highest points). Top-two-box is easier to explain and less sensitive to a few extreme answers.
  • single choice: Read the share choosing each option, then cross-tab by a segment question to see who differs.
  • matrix: Compare rows on the same column (for example, % agree) to find the weakest statement, then look at who rates it lowest.

Frequently asked questions

Does a patient satisfaction survey need HIPAA safeguards?

If it collects no health information and is anonymous, generally no. If you link responses to patient records or ask about conditions, treat it as protected health information and get advice.

How long does the patient satisfaction survey take to complete?

About 3 minutes: 7 questions, most of them single-tap. Every question can be edited, removed or reordered in the builder before you publish.

Is this template free to use?

Yes. Every template is included on the Free plan. Sign up, click Use this template, and it is copied into your workspace where you can edit it, add your logo and share it by link, email or embed.

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