About this template
Gathering actionable feedback from patients is essential for improving care quality, refining clinic operations, and boosting overall satisfaction. This patient satisfaction survey template provides a structured way for medical practices, clinics, and healthcare providers to collect honest opinions on everything from the booking process and front-desk staff to facility cleanliness and physician care.
With Doc2Form, you can instantly turn this template into a live Google Form, making it simple to share via email, text, or a website embed. Patients can fill it out effortlessly on any mobile device or computer.
Use the collected insights to identify bottlenecks like long wait times, highlight outstanding staff performance, and make data-driven decisions that enhance the patient experience at every touchpoint.
Key features
- Collect structured ratings for medical care, staff professionalism, and facility hygiene.
- Measure overall Net Promoter Score with patient recommendation likelihood.
- Identify operational bottlenecks like check-in delays and wait times.
- Fully mobile-friendly so patients can complete it from any device.
- Instant conversion to Google Forms for seamless data collection.
Use cases
Post-appointment feedback for family practices and specialist clinics.
Evaluating virtual care and telehealth visit experiences.
Measuring patient contentment across outpatient departments and hospi…
Measuring patient contentment across outpatient departments and hospital wings.
What this form collects
- Is this your first visit to our practice? (Multiple choice)Select your visit status.
- How often do you visit our facility? (Dropdown)Choose the option that best describes your visit frequency.
- What is your insurance plan status? (Multiple choice)Indicate how your visit is being covered.
- Booking Process Satisfaction (Linear scale)How easy was it to schedule your appointment?
- Check-In & Welcome Satisfaction (Linear scale)Rate your experience with the front desk and check-in process.
- Did your appointment start on time? (Multiple choice)Select whether you experienced any schedule delays.
- Staff Professionalism (Linear scale)Rate the helpfulness and courtesy of our administrative and support staff.
- Facility Hygiene & Cleanliness (Linear scale)How satisfied were you with the cleanliness of the waiting area and exam rooms?
- Doctor / Provider Care (Linear scale)Rate the quality of care, attentiveness, and communication from your medical provider.
- How likely are you to recommend our practice to friends or family? (Linear scale)0 = Not at all likely, 10 = Extremely likely.
- Comments & Suggestions (Paragraph)Please share any additional feedback, praise, or suggestions on how we can improve our service.
FAQ
How do I share this survey with patients?
Once Doc2Form generates your Google Form, you can share it via a direct link, email your patients after their visit, or embed the form directly onto your practice's website.
Can I add custom questions specific to my clinic?
Yes! Because the template lives in your Google Drive as a standard Google Form, you can easily add, remove, or edit any questions to match your practice's needs.
Are patient responses kept confidential?
Google Forms collects responses securely in your linked Google Sheet. You can configure your form settings to collect responses anonymously if desired.
How do I analyze the survey results?
All submissions instantly populate a Google Sheet, allowing you to review individual responses, track satisfaction trends over time, or create visual charts.
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.