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Patient satisfaction form template

This survey template gauges the ease with which patients can make appointments, the professionalism and friendliness of the staff, and the quality of care provided during their healthcare visits.

It also evaluates patients' likelihood to recommend the healthcare services to others, enabling a comprehensive understanding of patient satisfaction and experience.

Patient satisfaction form survey

Example questions

1. How would you rate your overall satisfaction with the care you received?

(1 being poor, 5 being excellent)

2. How would you rate the following aspects of your visit?

1 being not satisfied at all, 5 being extremely satisfied)

3. How well did your healthcare provider listen to your concerns and answer your questions?
4. How well did your healthcare provider explain your diagnosis, treatment options, or any recommended tests?
5. Did you feel involved in making decisions about your care and treatment?
6. How would you rate the quality of care provided by your healthcare provider?

(1 being poor, 5 being excellent)

7. How likely are you to continue using our services for your healthcare needs?

(1 being not likely at all, 5 being extremely likely)

8. How likely are you to recommend our healthcare services to a friend or family member?

(1 being not likely at all, 5 being extremely likely)

9. What aspects of our healthcare services do you think we could improve?
10. Please provide any additional feedback or comments about your experience with our healthcare services:

Patient Satisfaction Form Template Builder

Explore LimeSurvey's patient satisfaction survey builder and create surveys that will help you gather valuable insights into the effectiveness of your healthcare services and improve the overall patient experience.

  • Easy and simple to use
  • Statistics
  • Questionnaire templates
  • GDPR compliance
  • So much more…

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Patient satisfaction survey forms allow healthcare providers to gather valuable feedback from their patients, identify areas for improvement, and ultimately enhance the quality of care they provide, leading to higher patient satisfaction and improved health outcomes.
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