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Questionnaire template

Healthcare Appointment Experience

Measures patients' experience of booking an appointment and of their consultation with the practitioner.

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Business · Booking forms. All Business templates

Questions in this template

Booking Your Appointment

  1. Thank you for visiting us. Please tell us about your most recent appointment so we can improve the care we offer.

  2. How did you book your appointment?

    Choose one from a list:

    • Online
    • By phone
    • In person

  3. How easy was it to get a date and time that suited you?

    Choose one:

    • Very easy
    • Somewhat easy
    • Neither easy nor difficult
    • Somewhat difficult
    • Very difficult

  4. Overall, how satisfied were you with booking the appointment?

    Choose one:

    • Very dissatisfied
    • Somewhat dissatisfied
    • Neither satisfied nor dissatisfied
    • Somewhat satisfied
    • Very satisfied

Your Consultation

  1. How would you rate the practitioner you saw on each of the following?

    • Professional manner
    • Explaining things clearly
    • Understanding your health concerns

    For each row: choose one:

    • Very poor
    • Poor
    • Fair
    • Good
    • Excellent

  2. Which parts of your visit did you value most? Select all that apply.

    Choose any that apply:

    • Being seen on time
    • Clear explanations
    • Time given to me
    • Quality of care
    • Comfort of the room
    • None of these

  3. Is there anything our practitioners could do better?

    Open answer