HeySurvey survey

Patient Experience Feedback Survey

How satisfied were you with your overall visit today?*

Think about your full experience, from check-in to the end of your visit.

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5

Very dissatisfied to Very satisfied

What was the main reason for your visit?*

Choose the option that best matches your appointment.

Routine check-up
Follow-up visit
New health concern
Test or procedure
Prescription refill
Other

Which parts of your visit went well?

Select all that apply.

Scheduling the appointment
Check-in process
Wait time
Staff friendliness
Provider communication
Cleanliness of the facility
Instructions after the visit

Did your care team listen carefully to your concerns?*

Please answer based on your most recent visit.

Yes, completely
Mostly
A little
Not at all

How easy was it to understand the information you received?*

This includes explanations about your condition, treatment, or next steps.

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5

Very difficult to Very easy

About how long did you wait before being seen?

Your best estimate is fine ⏱️

Less than 10 minutes
10–20 minutes
21–30 minutes
31–45 minutes
More than 45 minutes

What could we do to improve your experience?

Share any ideas that would make future visits better for you.

Would you recommend this clinic or practice to others?*

A quick rating helps us understand overall patient trust.

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4

5

Definitely would not to Definitely would

Is there anything else you would like us to know?

You can share feedback, concerns, or a positive note 💬