Patient Satisfaction Survey Template

Patient Satisfaction Survey Template is a complete questionnaire that offers questions and examples for patient satisfaction survey for hospitals, clinics and medical professionals. Survey makers can use this ready-made and mobile friendly sample to collect and automatically analyze patient satisfaction survey responses and insights in real-time!



   
 
 


Please take a few minutes to fill out this survey on the relevance and quality of service you have received. {Hospital Name} Honors your feedback and your responses will be used to improve our future performance. Thank you for your input.

 
   
 
1. Overall how would you rate the quality of service you have received today?
 
Very Good
 
Good
 
Average
 
Poor
 
Very Poor
 
N/A
 
   
 
2. On average, how often do you visit the hospital in a given year?
 
Less than 1 Visit
 
1-2 Visits
 
3-5 Visits
 
More than 5 Visits
 
   
 
3. Are you currently covered under a health insurance plan?
 
Yes
 
No
 
   
 
5. Did you have any issues arranging an appointment?
 
Yes
 
No
 
   
 
6. How would you rate our concern for your privacy and transparency?
 
Very Good
 
Good
 
Average
 
Poor
 
Very Poor
 
   
 
7. How would you rate the professionalism our staff ?
 
Very Professional
 
Somewhat Professional
 
Neutral
 
Somewhat Unprofessional
 
Unprofessional
 
N/A
 
   
 
8. How likely is it that you would recommend our facility to a friend or family member?
 
Very Likely
 
Somewhat Likely
 
Neutral
 
Somewhat Unlikely
 
Very Unlikely
 
N/A
 

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