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
Thank you for taking part. Please think about your most recent visit; your feedback helps us improve the care we provide.
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Overall, how would you rate the care you received at your most recent visit?
Choose one:
- Excellent
- Very good
- Good
- Fair
- Poor
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How satisfied were you with how long you waited before being seen?
Choose one:
- Very satisfied
- Satisfied
- Neither satisfied nor dissatisfied
- Dissatisfied
- Very dissatisfied
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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
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How would you rate the way the clinician who saw you communicated with you?
Choose one:
- Excellent
- Very good
- Good
- Fair
- Poor
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How well did the clinician listen to what you had to say?
Choose one:
- Very well
- Well
- Moderately well
- Slightly
- Not at all
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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
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Is there anything else you would like to tell us about how staff communicated with you?
Open answer
Our Facility
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How would you rate the cleanliness of the facility?
Choose one:
- Excellent
- Very good
- Good
- Fair
- Poor
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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
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How could we make the facility more comfortable or easier to use?
Open answer
Follow-Up and Priorities
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Did you get enough support with follow-up care after your visit?
Choose one:
- Yes
- Not sure
- No
- No follow-up was needed
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How likely are you to recommend our services to friends or family?
Choose one:
- Very likely
- Likely
- Neither likely nor unlikely
- Unlikely
- Very unlikely
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Which new services or improvements would you most like us to offer?
Open answer
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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