Free Patient Experience Survey template

Patient experience is measured everywhere and acted on rarely, usually because the survey asks about satisfaction in general rather than about the parts of a visit a clinic can change. This template asks about the specific stages: getting an appointment, the wait, whether the clinician listened, explained things understandably, left time for questions and involved the patient in decisions, and whether the patient left knowing what happens next. Two short grids, on the same agree–disagree scale as the clinician's, cover the practical side — reception, cleanliness, the waiting area and privacy — and whether pain was managed, medicines were explained and the patient felt safe, each with a Not applicable choice.

That question about what happens next matters more than its length suggests. Patients who leave unclear about the next step are the ones who miss follow-ups, call back with avoidable questions, and report poor experiences for reasons unrelated to their clinical care. Every rating runs on five points, so the scores sit side by side, and the standard recommend question (0 to 10) sits alongside an overall rating and two open questions. An optional last page asks age group and, as two separate questions, whether the patient needed help to get to the visit and help to communicate. The first page also asks, in the patient's own words, which clinic or department the visit was with, so results from several sites can be told apart.

Health responses are sensitive by definition. The intro tells patients their answers will not affect their care and asks them not to include medical details. Consider a consent notice explaining what you will do with the answers, and a retention window so responses are deleted automatically once you have acted on them — both are per-survey settings, and both are the kind of thing a patient is entitled to ask about.