HeySurvey survey

Patient Experience Feedback Survey ✨

How easy was it to get the care you needed?*

Think about scheduling, wait time, and how simple the process felt.

1

2

3

4

5

Very difficult to Very easy

What type of visit did you have?*

Choose the option that best matches your most recent experience.

Routine check-up
Specialist appointment
Urgent care visit
Follow-up visit
Test or procedure
Other

Did our staff treat you with courtesy and respect?*

Please rate your overall experience with everyone you interacted with.

1

2

3

4

5

Never to Always

Which parts of your visit went well?

Select all that apply.

Scheduling the appointment
Check-in process
Wait time
Communication from staff
Provider listened carefully
Explanation of treatment or next steps
Cleanliness and comfort
Billing or insurance support

How clearly did your provider explain your condition or treatment?*

Choose the answer that best reflects your experience.

Not clear at all
Slightly clear
Mostly clear
Very clear
Extremely clear

What could we do to improve your experience?

Share any ideas that would help us provide better care next time.

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

Please rate how much your preferences and questions were included.

1

2

3

4

5

Not involved at all to Very involved

Was your privacy respected during your visit?*

Think about conversations, exam spaces, and handling of your information.

Yes, completely
Mostly
Not sure
A little
No

Is there anything else you'd like us to know? 🙂

You can share a compliment, concern, or any detail we may have missed.

Thank you for taking a part in this survey.

This is a HeySurvey survey template.