Patient Satisfaction Survey Questions + Sample Questionnaire Template

Patient Satisfaction Survey Questions Template is a complete sample questionnaire that offers industry tested questions and examples for measuring patient satisfaction for hospitals, clinics, and medical institutions / individual professionals. Researchers can use this ready-made and mobile friendly sample survey to collect and automatically analyze patient satisfaction survey responses and insights in real-time. Whether you are a hospital, clinic or any other medical institution, your patients are your customers, while you also owe them a moral and professional responsibility. From an ethical and medical profession standpoint - every institution has a responsibility to its patients. From a business standpoint, your patients are your customers and patient satisfaction is critical to ensuring the success of your medical facility/institution. This sample survey questionnaire is here to help you receive precise insights into patient satisfaction. You can also use this as an example template and edit it as it fits your requirements.


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.

Q1. On a scale of 0-10, considering your complete experience with our medical facility, how likely would you be to recommend us to a friend or colleague?
«Very UnlikelyVery Likely»
Q2. Please state your level of satisfaction with the process of booking an appointment with your doctor
Very Satisfied
Very Unsatisfied
Q3. Please rate your primary healthcare provider in:
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Conducting a swift diagnosis
Prescribing medications
Q4. Are you currently covered under a health insurance plan?
Q5. When requesting an appointment, were you given a chance to see your primary provider?
Q6. How long did you have to wait (past the appointment time) to meet the doctor?
0-30 minutes
30-60 minutes
More than an hour
More than two hours
Q7. Is the healthcare facility the one you usually visit in case of a health problem?
Q8. Since how many months/years have you been visiting this healthcare facility?
< 6 months
Between 6 months to a year
Minimum 1 year but less than 3 years
Minimum 3 years but less than 5 years
Minimum or more than 5 years
Q9. In the past year, how frequently did you visit your healthcare facility?
Not at all
More than 5 times
Q10. 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
Q11. How often did you receive conflicting information from different medical care professionals at this hospital?
Q12. Were you informed about the side effects and adverse symptoms of the medicines prescribed to you?
Q13. How satisfied were you with the following during your treatment at our medical facility?
Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied
Professionalism of our staff
Hygiene at the medical center
Care provided by medical personnel
Time that a doctor spent with you
Attentiveness towards concerns
Co-ordination between different departments
Q14. Were you asked today, if you had seen any health care providers besides us since your last visit?
Q15. Do you feel that our work hours are well suited to treat you?
Strongly Agree
Strongly Disagree
Q16. How convenient is our facility’s location for you?
Somewhat Convenient
Somewhat Inconvenient
Q17. How easy was it to navigate your way across our facility, to your destination with ease?
Very Easy
Very Difficult
Q18. How would you rate us on the following parameters?
Very Good Good Average Poor Very Poor
Our concern for your privacy and transparency
Quality of service received
Information provided towards leading a healthier life
Q19. Do you know about all the healthcare services we offer?
I was told about all of them without asking
I was told after I asked for them
I was not told about them
Q20. How easy was it to get a follow-up appointment?
Very Difficult
Very Easy
Q21. After your laboratory test, how many days did it take for you to receive your test results?
0-2 days
3-5 days
6-7 days
7+ days
Q22. Did the pharmacy staff bill your health provider and collect the right deductible from you for your medicines?
Q23. Did you find all your prescribed medicines in our pharmacy?
Q24. Have we helped you find other services you need that we do not provide?
Q25. Do you have any other feedback for us?

Why conduct a Patient Satisfaction Survey?

In many cases, certain facets of a medical facility’s functioning remain unaddressed due to an infrequent collection of patient feedback and the sheer lack of information regarding those issues faced by patients while availing for consultation and treatment. This is where patient satisfaction surveys provide an effective platform for patients to provide an honest feedback, based on their experience. Let’s look at why conducting periodic patient satisfaction surveys are critical towards maintaining and growing your patient visitors. There are five reasons why you should conduct a patient satisfaction survey.

  • Map and track a patient’s journey: It is important for a medical institute to keep track of their patient's satisfaction, based on the provided effective care. In order to ensure effective patient care at every point of significant interaction with the medical staff, and your institution at large, it is always recommended to conduct patient satisfaction surveys at multiple points of their journey. This enables you to track the points where satisfaction is low and remedy them.
  • Gather data about the patient loyalty: Including a Net Promoter Score question: “Considering your complete experience with our medical facility, how likely would you be to recommend us to a friend or colleague?” - will help you understand how loyal your patients are as each patient will definitely talk to their friends and colleagues about their experience after they are done with their treatment.

    On the basis of their responses, patients will be divided into three categories: Promoters (9-10), Passives (7-8) and Detractors (0-6).

    In many cases, if patients have had a terrible experience (i.e. detractors) or a pleasant experience (i.e. promoters), they will definitely talk about the experience within their network of friends and colleagues. While a terrible experience will cause damage to your facility’s reputation, a pleasant experience will definitely be successful in building a positive reputation.

    Thus, hospital authorities should calculate their Net Promoter Score either at every patient journey touchpoint or towards the end of their treatment to constantly ensure that issues by detractive patients are addressed, efforts are made to convert passives into promoters and promoters are kept satisfied with each treatment experience.

  • Report any ill-treatment by staff members: A patient satisfaction survey template promotes transparency by providing patients a medium to talk about any ill-treatment from hospital staff and bring it to the management’s notice. The management can take a step to either fire those staff members or train them to be respectful towards each and every patient who visits the medical facility.
  • Effective patient care: By conducting a patient satisfaction survey, medical institutions can analyze the gap between patient demands and their provisions. Medical facilities can improve visibility into their operational efficiency, which can be used to bridge the identified gap.

    Every industry has become customer-centric, and the healthcare sector is no different. There are a considerable number of areas in a medical institution’s operations which need improvement and this is where learning from the customers directly becomes effective. Your hospital or healthcare organization can include questions about how you can serve the patients better to keep evolving according to the evolution happening in patient thoughts and opinions.

  • Offer timely services to patients: 8 out of 10 medical authorities were of the opinion that they attended all their patients precisely at their respective appointment slots. Whereas, almost 50% of patients opined otherwise - they never get called in at their precise appointment time.
  • Gain insights about hygiene levels: Hygiene levels of a hospital reflect on how well-maintained it is and there is a significant sample of patients who would prefer visiting a hospital offering clean and hygienic facilities. You can include questions regarding this aspect of the questionnaire.

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