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No signup required · 8 questions · Anonymous
Patient Survey TemplateFree

Free Patient Satisfaction
Survey Template

8 questions covering care quality, provider communication, wait times, and likelihood to recommend. Know how your patients truly feel — and fix what's quietly damaging your reputation.

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No signup required · Free forever · Ready in 60 seconds

GP
DX
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Built for medical practices, clinics & healthcare providers

🏥 Patient Feedback
How was your visit with us today?
Anonymous · 8 questions · Under 3 minutes
1 of 8
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✓ 100% anonymous
✓ No patient signup
✓ Share via QR or text
✓ Live results dashboard
✓ Up to 100 responses free
Template Questions

All 8 Patient Survey Questions

Eight questions map the complete patient care journey — from the moment they arrive to the moment they leave. Question 2 (provider communication) is the single dimension most correlated with patient loyalty, online review scores, and word-of-mouth referrals. Question 3 (wait time) is the dimension patients complain about most in open text — getting a score on it before they write a review gives you a chance to act.

01How would you rate your overall experience at our practice today?Scale 1–5
02How well did your doctor or provider communicate and listen to your concerns?Scale 1–5
03How satisfied were you with your wait time today?Scale 1–5
04How friendly and helpful was our staff?Scale 1–5
05How would you rate the cleanliness and comfort of our facility?Scale 1–5
06How likely are you to recommend our practice to a friend or family member? (0–10)NPS Scale
07Would you return to us for future care?Yes / No
08Is there anything we could improve to make your next visit better?Open Text
The Care Journey

What Each Question Measures

Patient satisfaction isn't a single feeling — it's the sum of every touchpoint across the care journey. A patient who loved the doctor but waited 45 minutes and dealt with an unfriendly receptionist will not leave a 5-star review. This template covers all four stages of the experience your healthcare patient feedback needs to capture.

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Arrival
Wait time and first impressions. Questions 3 and 4.
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Care
Provider communication and care quality. Questions 1 and 2.
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Environment
Facility cleanliness and comfort. Question 5.
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Loyalty
NPS, return intent, and open feedback. Questions 6, 7, 8.

Patient loyalty is built in the first three stages but measured in the fourth. A practice with excellent clinical outcomes but poor wait time management and unfriendly front desk staff will see it in their NPS and their Google Reviews — usually at the same time. This patient satisfaction survey template gives you the data before it becomes a public problem.

How It Works

From Checkout to Insights in 3 Steps

1
Use This Template
All 8 questions pre-loaded. Add your practice name before sharing.
2
Share post-visit
Text link, QR code at checkout, or post-visit email. No patient login needed.
3
Act before reviews
Low scores flag dissatisfied patients before they reach Google or Yelp. Address the gap early.
Sample Results

Your Patient Satisfaction Dashboard

After 94 patients responded over a four-week period, here's what the dashboard shows — the wait time gap is the clearest operational improvement to address immediately:

Patient Satisfaction Survey · 94 responsesRolling 4 weeks
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Overall care rating
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Net Promoter Score
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Return for future care
Overall experience4.4 / 5
Provider communication4.7 / 5
Wait time3.1 / 5
Staff friendliness4.5 / 5
Facility quality4.3 / 5
Wk 1Wk 2Wk 3Wk 4Wk 5Wk 6Wk 7Wk 8
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Track patient satisfaction trends over time
See whether scores improve after staffing changes, wait time initiatives, or facility upgrades.
Unlock with Pro — $19/month
FAQ

Frequently Asked Questions

Is this patient satisfaction survey template free?
Yes. Free forever with no signup from you or your patients. Up to 100 responses free. Pro ($19/month) allows 10,000 responses — better for busy practices collecting patient feedback continuously.
What questions should a patient satisfaction survey include?
The most valuable patient satisfaction survey questions cover: overall care experience, provider communication and listening, wait time satisfaction, staff friendliness, facility cleanliness, likelihood to recommend (NPS), return visit intent, and open feedback. This template covers all eight dimensions.
When should I send a patient satisfaction survey?
Send within 24 hours of the appointment while the experience is fresh. Text or email surveys immediately post-visit achieve the highest response rates. Avoid sending more than 48 hours after — patient recall decreases and response rates drop significantly.
Does this patient survey comply with HIPAA?
VoteGenerator collects survey responses anonymously — no names, email addresses, or patient identifiers are stored. However, practices should consult their compliance officer before implementing any patient communication tool to confirm it meets their specific HIPAA requirements.
How do I share this survey with patients?
Share via text post-appointment, in your patient portal, on printed cards at checkout, via QR code in the waiting room, or in your post-visit email. No login required from patients — they click and respond immediately in their browser.
Can I use this for dental or specialist practices?
Yes. Works for any healthcare setting — GP practices, dental offices, specialist clinics, physiotherapy, mental health, and urgent care. All 8 questions are editable. Replace "doctor" with "dentist" or "therapist" before sharing.
How do I use patient feedback to improve care?
Focus on the gap between your highest and lowest dimension scores. If care quality scores 4.6 but wait time scores 2.8, wait time management is your operational priority. The open text question reveals specific patient concerns. Aggregate at least 20 responses before drawing conclusions to avoid outlier bias.

Know how your patients feel — before they post online

8 questions. Anonymous. QR code and text friendly. No signup from anyone.

Use This Template — Free

No signup required · Free up to 100 responses · Pro from $19/month