Introducing User Segmentation — Deliver surveys and feedback forms with precise targeting using powerful User Segments. Learn more ➝

Get it For Free
Request a Demo

Book a Demo with Zonka Feedback


Get Started for Free

Enter primary contact's full name
Enter primary contact's email address
Choose a password (at least 6 characters, no spaces, case-sensitive)
  • Your account is being created in the
By proceeding, you agree to the Terms of Service and Privacy Policy.
Or, sign up with email

user-picsrating-star crowd-logo captera-logo Rated 4.8/5 stars

Doctor Feedback Survey Questions

Use this doctor feedback form template to collect feedback from your patients about their visit, the practitioner who handled them, and other appointment-related details.

  • Try 14 days for Free
  • Lightening fast setup

Understanding Doctor Feedback Form Template

This feedback form has been created to help you learn more about a patient's experience during their doctor's appointment. You can collect data around how comfortable they were with the initial booking process, to the kind of questions the practitioner had asked them. Use the data to analyze and improve patient satisfaction across the medical facility.

Get started right away with a free trial. 


Ready to take it a step further?

With Zonka Feedback, you can create the survey as you like. The first step is to select the feedback survey template, then you can customize the design such as adding your logo, and background that matches your website, changing your font, and more. 

You can add multiple questions to the template as the people’s attention is on the lower side, so you can ask for relevant information which you can leverage. Click on the template to get started. 


List of Doctor Feedback Survey Questions

The following questions are included in Doctor Feedback Survey Template:

  • Let's get started with your name?
  • What was the purpose of your visit?
  • And, did you get an appointment slot at a time that is convenient for you?
  • How easy was it for you to schedule an appointment?
  • Do you think your doctor was attentive to your health concerns?
  • Did they listen to your medical history before making a diagnosis?
  • Did the doctor give you clear instructions about dosage & medication?

Sign Up on Zonka Feedback for free and implement this Doctor Feedback Survey Template in your account to collect feedback from customers.


FAQs about Doctor Feedback Survey Questions

1. How to write an amazing doctor feedback survey form?

A good feedback form is short, sweet, and to the point. Here are some things you can keep in mind to write a good feedback form template: 

  • Keep it short
  • Keep it simple
  • Make the feedback experience seamless
  • Have consistent rating scales
  • Personalize your request for feedback

2. Can I customize the doctor feedback form?

Yes, Zonka Feedback offers hospitals the chance to edit the template with ease. There’s no fuss when adding the questions, you can edit the questions with a simple click and choose from the various question types such as dropdown, checkbox, button choice, and more. 

3. Where can I use this Doctor Feedback Feedback Form?

You can use a QR code at your touchpoint. Another method is to send an email or SMS survey to the customer once the service is completed. If you don't have access to the internet, you can conduct offline surveys using kiosks, mobile devices, or tablets. 

Create and send this Doctor Feedback Survey Questions

Get Started