About this template
The CAHPS Clinician & Group Survey Version 3.0 (Adult) is a standardized questionnaire designed to evaluate adult patients' experiences with healthcare providers and facilities. This comprehensive survey captures critical metrics on provider communication, appointment access, staff courtesy, and overall care satisfaction.
Healthcare practices, clinics, and health systems use this tool to gather actionable patient feedback, support quality improvement initiatives, and track performance benchmarks. By collecting structured responses on wait times, listening skills, and explanations, organizations can identify areas for operational and clinical enhancement.
With Doc2Form, you can instantly turn this assessment into a ready-to-use Google Form. Seamlessly collect responses and analyze patient satisfaction data directly in your workspace.
Key features
- Assess patient satisfaction with provider communication and care access.
- Evaluate front-desk staff courtesy, helpfulness, and office efficiency.
- Capture standard demographic and general health status metrics.
- Analyze responses instantly using integrated spreadsheet tools.
Use cases
- Outpatient clinic and private practice patient experience evaluations.
- Annual quality assurance and patient satisfaction reporting.
- Telehealth and virtual care provider performance reviews.
What this form collects
- Provider Confirmation Status (Multiple choice)Is this the provider you usually see for your healthcare?
- Usual Provider Status (Multiple choice)Do you consider this provider to be your primary care provider?
- Provider Visit Frequency (Dropdown)In the last 6 months, how many times did you visit this provider for care?
- Urgent Appointment Timeliness (Multiple choice)In the last 6 months, when you needed care right away, how often did you get an appointment as soon as you needed?
- Routine Appointment Timeliness (Multiple choice)In the last 6 months, when you made an appointment for a routine visit, how often did you get an appointment as soon as you needed?
- Easy-to-Understand Explanations (Multiple choice)In the last 6 months, how often did this provider explain things in a way that was easy to understand?
- Careful Listening Frequency (Multiple choice)In the last 6 months, how often did this provider listen carefully to you?
- Medical History Awareness (Multiple choice)In the last 6 months, how often did this provider seem to know the important information about your medical history?
- Respect Shown Frequency (Multiple choice)In the last 6 months, how often did this provider show respect for what you had to say?
- Enough Time Spent Frequency (Multiple choice)In the last 6 months, how often did this provider spend enough time with you?
- Provider Rating (Linear scale)Using any number from 0 to 10, where 0 is worst possible provider and 10 is best possible provider, what number would you use to rate this provider?
- Clerks Helpfulness Frequency (Multiple choice)In the last 6 months, how often were clerks and receptionists at this office as helpful as you thought they should be?
- Clerks Courtesy & Respect Frequency (Multiple choice)In the last 6 months, how often did clerks and receptionists at this office treat you with courtesy and respect?
- Overall Health Rating (Dropdown)In general, how would you rate your overall health?
- Mental/Emotional Health Rating (Dropdown)In general, how would you rate your overall mental or emotional health?
- Age Range (Dropdown)What is your age category?
- Sex (Multiple choice)What is your sex?
- Education Level (Dropdown)What is the highest grade or level of school that you have completed?
- Hispanic/Latino Origin Status (Multiple choice)Are you of Hispanic or Latino origin or descent?
- Race (Checkboxes)What is your race? Select all that apply.
- Survey Assistance Status (Multiple choice)Did someone help you complete this survey?
- Type of Assistance Provided (Checkboxes)If someone helped you, how did they help? Select all that apply.
FAQ
What is a CAHPS Clinician & Group Survey?
It is a standardized questionnaire developed to assess patients' experiences with healthcare providers, focusing on communication, access, and overall satisfaction.
Why is this survey important for healthcare providers?
It provides valuable insights into patient experiences, supports quality improvement initiatives, and helps practices meet regulatory and accreditation goals.
How can I customize this template?
Once imported via Doc2Form, you have full control over your Google Form to add supplemental questions, adjust branding, or modify fields as needed.
Where are survey responses stored?
All submissions are securely saved in your connected Google Sheets spreadsheet for seamless review and analysis.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.