Patient Satisfaction Survey Template
Fifteen questions that ask patients what actually happened at one visit, from booking the appointment to leaving with a plan.
- 15questions
- About 3 minfor the patient
- One visitclinic, dental or telehealth
- No identifiersno name, no record number
The 15 patient satisfaction survey questions
A patient satisfaction survey asks patients about one visit: getting the appointment, time with the clinician, checking in, and leaving with a plan. Eleven of these questions ask what happened, which a practice can act on; two ask for comments and two for an overall judgment. All fifteen are ready to edit in the free questionnaire maker.
Getting seen
Booking and the wait, before anyone is treated. To rate the booking phone call itself, use the post call survey.
- Did you get this appointment when you needed it?a run of 1s and 2s is capacity, not staff.
- Did this visit start close to the time you were given?a schedule problem, not a clinical one.
Your clinician
Four items kept apart, so a low overall rating traces to one of them.
- Did the clinician seem prepared for your visit?
- Did the clinician listen to what you came in to say?
- Were you given enough time to ask what you wanted to ask?if question 4 scores high, book longer slots.
- Did the clinician ask for your view before deciding what happens next?a flat 3 suggests a plan announced, not agreed.
Staff and the practice
Everything around the consultation, which the practice can fix without a clinician.
- Was checking in at the front desk easy?
- Was the waiting area clean when you arrived?
Leaving with a plan
What the patient walked out holding.
- Did you leave knowing what to do next?high clinician scores with a low answer here: write the plan down.
- Did you know who to contact if things changed?
- Were you told what you would have to pay, if anything?"if anything" keeps the item answerable after a visit with no bill.
In their words, then overall
Two optional comment boxes, then two ratings, so the survey ends on a number. For a 0 to 10 recommendation score, the NPS survey asks it that way.
- What was the one thing that went well at this visit?praise before criticism.
- What one thing would have made this visit better?
- Overall, how was this visit?the one number to trend.
- Would you recommend this practice to people you know?about the practice, not this visit; count a 3 as a no.
Dental and video visit swap-ins
Each one replaces the question its note names.
- Were you comfortable during your treatment?dental: in place of question 10.
- Were you told the cost before treatment started?dental: in place of question 11.
- Could you join the visit without needing help?video or phone visit: in place of question 7.
- Could you hear the clinician clearly for the whole visit?video or phone visit: in place of question 8.
How to use the patient satisfaction survey
Send it the morning after the visit to every patient seen the day before. The practice manager sends it, since question 7 rates the front desk. A patient seen every week gets it once a month.
For each question, count the share of 4s and 5s, the way the customer satisfaction survey scores its rating, month by month. Read the eleven what-happened items apart from the overall rating: AHRQ defines experience as whether care happened, and satisfaction as whether expectations were met.[1] Tag each comment with the question it belongs to, so a complaint about the wait lands on question 2.
The form asks for no name, date of birth or record number; keep it that way when you edit it. For care given in the patient's own home, send the home care client satisfaction survey instead.
Patient satisfaction survey FAQ
How do you create a patient satisfaction survey?
Pick one kind of visit and ask what happened at each stage: booking, the wait, the clinician, the front desk and leaving. Add two optional comment boxes, then close on an overall rating. This template follows that order, ready to edit.
How is a patient satisfaction survey different from HCAHPS?
HCAHPS is the federal survey of hospital stays: 32 questions asked of a random sample of adult patients after discharge, with the results publicly reported.[2] This template covers one outpatient visit, and you choose the questions and when they go out.
How many questions should a patient satisfaction survey have?
Enough to cover each stage of the visit once, and no more. Fifteen does that here, about three minutes on a phone. Before adding a question, ask what you would change if its answers came back low.
Michael Hodge, survey methodology · Updated 25 September 2026 · How templates are reviewed
Hear from every patient you saw yesterday
Fifteen questions, about three minutes on a phone. Open it in the editor, add your practice name and send it tomorrow morning.
Use this template