Healthcare survey template

This healthcare survey template covers an array of topics including the overall patient experience, the specific department or service visited, and the quality of care provided.

It also solicits patient feedback on their involvement in decision-making, their likelihood of recommending the service, along with their suggestions for improvement and any additional comments.

Healthcare form survey

Example questions

1. How would you rate your overall experience with our healthcare facility?

(1 being poor, 5 being excellent)

2. Which department or service did you visit or utilize?
3. How satisfied were you with the following aspects of your visit?

(1 being not satisfied at all, 5 being extremely satisfied)

4. How would you rate the quality of care provided by your healthcare provider?

(1 being poor, 5 being excellent)

5. Were all of your concerns and questions addressed during your visit?
6. How well did your healthcare provider explain your diagnosis, treatment plan, or any recommended tests?
7. Did you feel involved in making decisions about your care and treatment?
8. How likely are you to recommend our healthcare facility to a friend or family member?

(1 being not likely at all, 5 being extremely likely)

9. Do you have any suggestions for improving our services or any additional services you would like to see offered?
10. Please provide any other feedback or comments about your experience with our healthcare facility

Healthcare Survey Template Builder

LimeSurvey's healthcare survey builder creates surveys that assess patient satisfaction with various aspects of their healthcare experience, providing valuable insights to improve the quality of care and service provided.

  • Easy and simple to use
  • Statistics
  • Questionnaire templates
  • GDPR compliance
  • So much more…

Related form templates

Best Healthcare Questionnaires and Feedback Form Templates

Healthcare survey forms help healthcare providers to collect feedback from patients about their experience and satisfaction with the care they received. This information can be used to improve services and ensure that patients receive high-quality care.