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Outpatient Satisfaction and OPD Feedback Form Template

Use our Post-Visit Outpatient Satisfaction and OPD Feedback Survey Template to improve your healthcare services for your patients during their appointment.

  • Try 7 days for Free
  • Lightening fast setup
Measure outpatient satisfaction post their visit at your healthcare centers and hospitals to improve outpatient experience using OPD feedback form. Gauge patients' perception about the medical care, treatment, waiting time, and find out gaps in your healthcare services.

OPD Feedback Form Template Questions

  1. 1. Please rate your overall satisfaction with your outpatient experience
  2. 2. How likely are you to recommend our clinic/hospital to your family or friends?
    • 0 (Not  at all likely)
    • 10 (Extremely likely)
  3. 3. Please rate the following aspects of your outpatient experience
    • Waiting Time
      • Very Poor
      • Poor
      • Average
      • Good
      • Excellent
    • Staff Friendliness
      • Very Poor
      • Poor
      • Average
      • Good
      • Excellent
    • Cleanliness and Hygiene
      • Very Poor
      • Poor
      • Average
      • Good
      • Excellent
    • Clarity of Instructions
      • Very Poor
      • Poor
      • Average
      • Good
      • Excellent
    • Quality of Care
      • Very Poor
      • Poor
      • Average
      • Good
      • Excellent
  4. 4. How would you rate the experience with the doctor who attended to you?
    • Very Poor
    • Poor
    • Average
    • Good
    • Excellent
  5. 5. Was the appointment booking process convenient and efficient?
    • Yes
    • No
  6. 6. How would you rate the ease of finding information about our clinic/hospital (e.g., location, services)?
    • Very Poor
    • Poor
    • Average
    • Good
    • Excellent
  7. 7. Did you receive timely reminders or notifications regarding your appointment?
    • Yes
    • No
  8. 8. Were the facilities and amenities at the clinic/hospital adequate and comfortable?
    • Yes
    • No
  9. 9. Did the healthcare provider explain your diagnosis and treatment plan clearly?
    • Yes
    • No
  10. 10. Were all your questions and concerns addressed during your visit?
    • Yes
    • No
  11. 11. Please provide any additional comments or suggestions for improvements
  12. 12. Would you like to be contacted for further feedback or follow-up?
    • Yes
    • No
  13. 13.  Personal Information
    • Full Name
    • Contact Number
    • Email Address
    • Patient ID

Create and send this Outpatient Feedback Form with Zonka Feedback

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