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Patient Satisfaction Survey Template

Gather important patient insights with our effective Patient Satisfaction Survey Template. Capture feedback at different touchpoints to improve the quality of care & treatment and deliver healthcare services that yield high-level Patient satisfaction. 

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  • Lightening fast setup
Get feedback from inpatients about their experience and satisfaction during stay at the hospital using this Patient Satisfaction Survey Template. 

Questions in Patient Satisfaction Survey Template

  1. 1. Please rate your satisfaction with the care provided during your visit
    • 1
    • 2
    • 3
    • 4
    • 5
  2. 2. How well did the healthcare provider communicate with you?
    • Very Poor
    • Poor
    • Average
    • Good
    • Excellent
  3. 3. Please rate your satisfaction with the following aspects: Wait Time, Staff Friendliness, Cleanliness, & Clarity of Communication
    • Very Poor
    • Poor
    • Average
    • Good
    • Excellent
  4. 4. Are you satisfied with the follow-up care after your visit?
    • Yes
    • No
  5. 5. To what extent do you agree or disagree with the following statement? It was easy for me to schedule the appointment
    • Strongly Disagree
    • Disagree
    • Somewhat Disagree
    • Neutral
    • Somewhat Agree
    • Agree
  6. 6. Is there anything we can do to improve your satisfaction as a patient?

How to Use Zonka Feedback's Patient Satisfaction Template for Hospitals?

Here are a few simple steps to quickly set up your Patient Satisfaction Survey Template.

  1. Click on 'Edit this Template': Click on the 'Edit this Template' option on this page. It will directly take you to the Market Research Survey Template.
  2. Customize the template: In the survey builder, you can go a step ahead by customizing the template to add branding elements. Access various customization features like white-labeling, answer piping, survey logic, pre-fill data, customizing question types, and more to make your surveys dynamic and engaging.
  3. Preview the survey: Before sending the survey, click on preview to see how the customers will perceive the template.
  4. Save the survey: After previewing the spa feedback form, click on ‘Save’ button.
  5. Prepare for distribution: With your survey ready, move towards the distribution. When sharing the survey, make sure that you choose the right channel to best engage your customers for effective feedback collection.

Here are channel-wise examples of how to effectively gather patient feedback using Patient Satisfaction Survey Templates:

1. SMS Survey

When to use:

  • Immediate post-appointment feedback: Gauge overall satisfaction, willingness to recommend, and any immediate concerns.
  • Reminders for detailed surveys: Prompt patients to complete more comprehensive surveys via email or website.

Example: "Hi [Patient Name], thank you for choosing us! How would you rate your overall satisfaction with your appointment today? Reply 1-5, 5 being the best."

2. Email Survey

When to use:

  • In-depth feedback: Gather comprehensive feedback on various aspects of the patient experience, including communication, wait times, staff courtesy, facility cleanliness, and overall satisfaction.
  • Targeted surveys: Reach specific patient groups for tailored insights (e.g., patients with chronic conditions, recent surgery patients).

Example: "Dear [Patient Name], your feedback is valuable to us. Please take a few minutes to complete this survey about your recent experience at our clinic." [Link to the Survey]

3. In-App Survey

When to use:

  • Real-time feedback: Capture feedback immediately after appointments or during interactions with the healthcare app.
  • Usability feedback: Gather input on app features, navigation, and overall user experience.

Example: "Thank you for using our app! Would you mind sharing your feedback on your experience today?" [Pop-up survey within the app]

4. Offline Survey (Kiosks)

When to use:

  • High-traffic areas: Gather feedback in waiting rooms, reception areas, or post-discharge lounges.
  • Patients without email or smartphones: Provide an accessible option for all patients to share their experiences by installing survey kiosks using Android and iOS devices.

Example: "Please take a moment to share your feedback about your visit today. Your input helps us improve our services." [Kiosk with touch-screen survey]

5. Website Survey

When to use:

  • Website experience feedback: Gather insights on website usability, navigation, appointment booking, information clarity, and overall visitor experience.
  • Target visitors to specific pages: Trigger surveys on pages related to patient experience or feedback.

Example: "We're committed to providing an excellent online experience. Please share your feedback on our website." [Pop-up survey on relevant webpages].

Key Features of IPD Feedback Form Template

Here are some of the advanced features of in-patient feedback form template.

  1. Survey Customization - Zonka Feedback offers full survey customization to create surveys that best reflect your brand. Access answer piping, pre-fill data, skip logic, white labeling, customizable question types and rating scales, and so on.
  2. Advanced Analytics - Access Zonka Feedback advanced analytics and reporting feature to track trends, measure staff performance, get quick overview, compare location-based insights, and more.
  3. Real-time Alerts - Set team notification and alerts based on customer feedback. Inform your teams of negative feedback for quick response action using Slack, MS teams, SMS, email, etc.
  4. Multi-lingual Surveys - Create surveys in over 45+ languages to make it convenient for your customers to express their experience and opinion.
  5. Workflow Automation - Create workflows to automate manual tasks to help your teams focus on improving customer issues. Automatically trigger surveys, set response alerts, teams notifications, and more to close the feedback loop faster and kep your customers engaged.

Best Practices to Collect Patient Feedback

  • Strategically combine channels for broader reach and richer insights.
  • Align survey content with the channel's strengths (e.g., brief questions for SMS, detailed surveys for email).
  • Personalize surveys when possible to increase engagement and response rates.
  • Act on feedback to demonstrate you value patient input and drive continuous improvement.

Create and send this Patient Satisfaction Survey with Zonka Feedback

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