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Healthcare patient satisfaction survey template

Healthcare patient satisfaction survey template

Gain insights into your patients’ experiences with our detailed satisfaction survey template. Use feedback to enhance care quality, patient engagement, and service delivery.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
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or Download template as PDF
Healthcare patient satisfaction survey template

Gain insights into your patients’ experiences with our detailed satisfaction survey template. Use feedback to enhance care quality, patient engagement, and service delivery.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

Transform patient feedback into tangible healthcare improvements with this patient satisfaction survey template. Featuring carefully crafted questions about care quality, staff interactions, facility conditions, and overall experience, this tool delivers insights that drive meaningful change.

More than 90% of dissatisfied patients won’t voice concerns directly but will simply seek care elsewhere, as stated by The American Association for Physician Leadership. By conducting regular satisfaction surveys, you create a feedback loop that catches issues before patients leave. Whether you’re measuring the impact of recent service changes or establishing baseline satisfaction metrics, this template allows you to collect consistent, comparable data over time.

Related categories

  • Health and safety management templates
  • Health care templates
  • Quality assurance templates
  • Templates for business processes
Preview of the template
Page 1
Patient Information
Patient Name
Patient ID
Date of Visit
Satisfaction with Care
How would you rate the overall quality of care you received?
How well did your healthcare provider listen to your concerns?
How would you rate the professionalism and courtesy of the staff?
How satisfied were you with the amount of time the provider spent with you?
How easy was it to schedule your appointment?
Satisfaction with Facility
How would you rate the cleanliness of the facility?
How would you rate the comfort and appearance of the waiting area?
How would you rate the ease of parking and access to the facility?
Overall Satisfaction
How likely are you to recommend this healthcare provider to your friends and family?
Please share any additional comments or feedback.

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Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

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Template collections

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Healthcare risk management softwareCompliance audit softwareField reporting softwareRisk assessment software
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Explore all the additional resources we offer to assist you in mastering this topic.

To whom is continuous improvement important4 benefits of safety management and how to communicate them4 ways process improvement increases profits5 ways workflow automation streamlines healthcare administration

Frequently asked questions

How can I use patient satisfaction survey results to improve my healthcare practice?

Analyze results to identify specific pain points, then create targeted improvement plans with measurable goals. Share findings with your entire team and involve them in developing solutions. Implement changes incrementally, measure their impact through follow-up surveys, and communicate improvements back to patients. This creates a visible feedback loop showing patients their input drives meaningful change.

Should I make my patient satisfaction survey anonymous or collect patient information?

Consider a hybrid approach—collect basic demographic information for segmentation while keeping individual responses confidential. Clearly communicate your privacy policy and how information will be used. Offer an optional identification field for patients who want direct follow-up. This balances getting honest feedback with the ability to address specific concerns and track individual patient experiences over time.

How can I benchmark my patient satisfaction survey results against industry standards?

Join healthcare quality improvement organizations that provide benchmarking data or partner with similar practices to share anonymized results. Consider using standardized survey instruments like CAHPS that offer comparative data. Focus on trending your own results over time first, then use external benchmarks as secondary comparison points to identify areas where your practice significantly outperforms or lags behind industry norms.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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