Patient Satisfaction Survey Questions Examples Pdf Survey

Patient Satisfaction Survey

Tell us about your most recent visit. Please do not include names, medical details, or other identifying information.

How easy was it to schedule your appointment?*

Think about the steps needed to book your visit.

Very difficult
Somewhat difficult
Neither easy nor difficult
Somewhat easy
Very easy
Not applicable—I did not schedule an appointment

How satisfied were you with the way staff treated you?*

Consider whether staff treated you with courtesy and respect.

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How long did you wait past your scheduled appointment time?*

Choose your best estimate of the time before a healthcare professional saw you.

I was seen on time or early
Less than 15 minutes
15–30 minutes
31–60 minutes
More than 60 minutes
Not applicable—I did not have a scheduled appointment

How clearly did your healthcare professional explain your care?*

Consider explanations about your health, treatment, or next steps.

Not at all clearly
Slightly clearly
Moderately clearly
Very clearly
Extremely clearly
Not applicable—no explanation was needed

How satisfied were you with the cleanliness of the facility?

Consider the areas you used during your visit. Skip this question if your visit was virtual.

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How involved did you feel in decisions about your care?*

Think about whether you had the chance to share your preferences.

Much less involved than I wanted
Somewhat less involved than I wanted
As involved as I wanted
More involved than I wanted
Not applicable—no care decisions were made

Which parts of your visit could be improved?

Select all that apply. Select “Nothing needs improvement” only if no other option applies.

Scheduling an appointment
Time spent waiting
Staff courtesy and respect
Communication about my care
Involvement in care decisions
Facility cleanliness
Other
Nothing needs improvement

Overall, how satisfied were you with your visit?*

Consider your experience from start to finish.

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What is one thing we could do to improve your next visit?

Please avoid sharing personal or medical information.

Thank you for taking a part in this survey.

This is a HeySurvey survey template.