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Questionnaire template

Patient Care Experience (Patient 2)

Measures patients' views of their latest visit: care quality, communication, facility, follow-up and what matters most.

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Questions in this template

Your Most Recent Visit

  1. Thank you for taking part. Please think about your most recent visit; your feedback helps us improve the care we provide.

  2. Overall, how would you rate the care you received at your most recent visit?

    Choose one:

    • Excellent
    • Very good
    • Good
    • Fair
    • Poor
  3. How satisfied were you with how long you waited before being seen?

    Choose one:

    • Very satisfied
    • Satisfied
    • Neither satisfied nor dissatisfied
    • Dissatisfied
    • Very dissatisfied
  4. How clearly was your health condition explained to you?

    Choose one:

    • Extremely clearly
    • Very clearly
    • Moderately clearly
    • Slightly clearly
    • Not at all clearly

Communication with Staff

  1. How would you rate the way the clinician who saw you communicated with you?

    Choose one:

    • Excellent
    • Very good
    • Good
    • Fair
    • Poor
  2. How well did the clinician listen to what you had to say?

    Choose one:

    • Very well
    • Well
    • Moderately well
    • Slightly
    • Not at all
  3. Were you involved as much as you wanted in decisions about your care?

    Choose one:

    • Yes
    • Partly
    • No
    • I did not want to be involved
  4. Is there anything else you would like to tell us about how staff communicated with you?

    Open answer

Our Facility

  1. How would you rate the cleanliness of the facility?

    Choose one:

    • Excellent
    • Very good
    • Good
    • Fair
    • Poor
  2. How satisfied were you with how easy it was to find your way around the facility?

    Choose one:

    • Very satisfied
    • Satisfied
    • Neither satisfied nor dissatisfied
    • Dissatisfied
    • Very dissatisfied
  3. How could we make the facility more comfortable or easier to use?

    Open answer

Follow-Up and Priorities

  1. Did you get enough support with follow-up care after your visit?

    Choose one:

    • Yes
    • Not sure
    • No
    • No follow-up was needed
  2. How likely are you to recommend our services to friends or family?

    Choose one:

    • Very likely
    • Likely
    • Neither likely nor unlikely
    • Unlikely
    • Very unlikely
  3. Which new services or improvements would you most like us to offer?

    Open answer

  4. Rank these parts of our service by how much they matter to you (1 = most important).

    • Quality of care
    • Communication with clinicians
    • Cleanliness
    • Waiting times
    • Support after the visit

    For each row: choose one from a list:

    • 1
    • 2
    • 3
    • 4
    • 5