Questionnaire template
Patient Care Satisfaction
Asks patients about their latest visit: overall satisfaction, ratings of care, areas to improve and likelihood to recommend.
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Other · Satisfaction. All Other templates
Questions in this template
Your Overall Experience
Please tell us about your most recent visit. Your answers are confidential and help us improve care for every patient.
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Overall, how satisfied were you with the care you received at your last visit?
Choose one:
- Very satisfied
- Satisfied
- Neither satisfied nor dissatisfied
- Dissatisfied
- Very dissatisfied
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How would you rate each of these parts of your visit?
- How long you had to wait
- How attentive the doctor was
- How professional the nursing staff were
For each row: choose one:
- Poor
- Fair
- Good
- Very good
- Excellent
Where We Can Improve
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In which areas should we improve? Select all that apply.
Choose any that apply:
- Waiting time
- Staff professionalism
- Cleanliness
- Communication
- Other
- No improvement needed
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Which other area should we improve?
Condition: Shown when Other is selected
Open answer
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If you could change one thing about the care we provide, what would it be?
Open answer
Recommending Us
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How likely are you to recommend us to friends or family?
Choose one:
- Not at all likely
- Unlikely
- Neither likely nor unlikely
- Likely
- Extremely likely
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Do you have any other comments or suggestions?
Open answer