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Patient satisfaction survey template

Patient satisfaction survey template

Understand your patient’s needs with our detailed satisfaction survey template. Collect feedback, identify areas for improvement, and enhance patient care.

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
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or Download template as PDF
Patient satisfaction survey template

Understand your patient’s needs with our detailed satisfaction survey template. Collect feedback, identify areas for improvement, and enhance patient care.

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

This patient satisfaction survey template empowers you to gather valuable feedback on patient experiences, identify service gaps, and drive meaningful improvements in care quality. It evaluates key aspects of the patient journey—from doctor interactions and communication quality to facility accessibility and financial concerns.

Research shows that medical care quality, communication with patients, and waiting times are among the most influential factors affecting patient satisfaction. Use this template to uncover specific pain points in your practice, such as long wait times or unclear medical explanations, allowing you to make targeted improvements that enhance patient outcomes and loyalty.

Related categories

  • Health and safety management templates
  • Quality management templates
  • Health care templates
  • Quality assurance templates
  • Safety templates
Preview of the template
Patient Satisfaction Survey
Patient Satisfaction Questionnaire
When I go to the doctor, they are careful to examine everything when treating and checking me
The medical care I have been getting was really good.
Doctors are not too serious and impersonal to me
Doctors do not make me question if their diagnosis is true.
I am certain that I can receive the medical care I need without being set back financially
Doctors describe the reason for medical tests well.
I have clear access to the medical specialists I need
I think my doctor's office has everything required to implement complete medical care.
Where I go for medical care, I do not have to wait too long for emergency medication
My doctors treat me in a very kind and polite manner
I have trust in the ability of the doctors who treat me.
I can get medical care whenever I need it.
Those who give me my medical care are not too much in a rush when they treat me
I do not have to pay more than I can afford/than necessary for my medical care
Doctors do not ignore what I tell them.
Doctors spend sufficient/plenty of time with me.
It's easy to get an appointment for medical care immediately.
I am happy with the medical care I got.
Patient's further comments:
This template was downloaded 47 times

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Related resources

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

Topic guides

Read in-depth guides covering key topics related to this article.

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Frequently asked questions

What key insights can I gain from using this patient satisfaction survey template?

This survey provides insights into multiple dimensions of patient experience—from provider communication and thoroughness to accessibility and financial concerns. You’ll learn specifically where patients feel valued or neglected, which aspects of care need improvement, and how your facility compares across different service areas. These insights help prioritize quality improvement efforts where they’ll have the greatest impact.

How should I distribute this patient satisfaction survey for maximum response rates?

Offer multiple completion options to increase participation. Provide the survey immediately after appointments via tablet or paper form when experiences are fresh. Follow up with email or text links for those who prefer responding later. Consider offering small incentives like entry into a gift card drawing. Always explain how feedback directly improves care quality to motivate participation.

How can I customize this patient satisfaction survey template for my healthcare facility?

Maintain the core questions for benchmarking purposes, but add facility-specific questions addressing your unique services or recent changes. Consider adding department-specific sections if patients interact with multiple areas. Adjust language to match your patient population’s literacy level and include translations for non-English speakers if needed.


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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