SurveyClinics / Hospitals / Diagnostics5 questions · ~3 min

Patient Satisfaction Survey template

This free Patient Satisfaction Survey template helps you hear from patients about their visit to a clinic, hospital or diagnostic centre. It has 5 ready-made questions, takes about 3 minutes to answer, and is anonymous by default. Customise every question, then share it by link, QR code or website embed.

Use this template — free All templates

Questions in this template

What was your visit for?
Single choice
Consultation · Diagnostic test or scan · Treatment or procedure · Follow-up · Emergency · Other
Overall, how satisfied are you with your visit? *
Rating scale
How would you rate…
Grid (matrix)
Booking an appointment · Waiting time · Reception staff · Doctor / clinician · How your care was explained · Cleanliness
How likely are you to recommend us to friends or family?
NPS (0–10)
What could we improve?
Long text

* required. Every question is editable.

Recommended settings

Visibility: Unlisted — only people with the link
Responses: Anonymous — not linked to accounts
Results: Only you and your workspace see results
One response per: Browser
Consent notice: Included — edit it to match your policy

Best for: Anonymous, ratings for each stage of the visit, NPS.

Industries: Healthcare.

Best practice for customer feedback

Ask at the moment of truth — right after a purchase, delivery or support case.
Track one headline metric (CSAT, NPS or CES) consistently over time.
Close the loop: thank customers and act on the top themes.

Patient Satisfaction Survey: frequently asked questions

What questions should a Patient Satisfaction Survey include?

A good Patient Satisfaction Survey is short and focused. This template asks: What was your visit for? · Overall, how satisfied are you with your visit? · How would you rate… · How likely are you to recommend us to friends or family? — plus 1 more. Remove anything you won’t act on.

Is the Patient Satisfaction Survey anonymous?

Yes. Responses are anonymous by default and aren’t linked to anyone’s account.

How long does the Patient Satisfaction Survey take to complete?

About 3 minutes — 5 questions. Shorter surveys get more responses.

Can I customise the Patient Satisfaction Survey template?

Yes. Every question, option and setting is editable before you publish, and you can add skip logic, pages, a cover image and translations into 20 more languages, from Chinese, Hindi and Spanish to Arabic, Bengali and Hausa.