Form questions

Patient satisfaction survey questions for a clinic

Ask 10 to 14 after a visit, anonymously. Never skip whether the clinician listened, whether things were explained clearly, and whether privacy was respected. Those experience questions, used in established patient surveys, point to changes a clinic can make, which a single satisfaction score cannot.

Patient satisfaction survey questions work best when they ask about specific experiences, such as whether the clinician listened and explained things clearly, rather than a general rating. These twenty four questions follow a visit from booking to leaving, and keep the experience questions separate from the overall score.

The questions

The visit

  1. What kind of appointment was it?Single choiceRequired

    Standard, long, telehealth, procedure, so results can be split.

  2. Was this your first visit to the clinic?Single choice

  3. How easy was it to get an appointment when you needed one?Single choice

    A five point scale from very hard to very easy.

  4. How did you book?Single choice

    Phone, online, in person.

Arriving and waiting

  1. How were you treated by reception?Single choice

  2. How long did you wait past your appointment time?Single choice

    Under 10 minutes, 10 to 20, 20 to 40, more than 40.

  3. Were you told about any delay?Single choice

  4. How clean and comfortable was the waiting room?Single choice

With the clinician

  1. How much do you agree with each statement?Rating gridRequired

    Rows: listened to me, explained things clearly, involved me in decisions, spent enough time, treated me with respect. Columns strongly disagree to strongly agree.

  2. Did you feel able to ask questions?Single choice

  3. Do you understand what happens next with your care?Single choice

  4. Were any costs explained before treatment?Single choice

Privacy and safety

  1. Did you feel your privacy was respected at reception and in the consultation?Single choice

  2. Were you asked to confirm your name and date of birth before any procedure?Single choice

  3. Did you feel safe during your visit?Single choice

Overall

  1. Overall, how satisfied were you with your visit?Single choiceRequired

    A five point scale. Ask it after the experience questions.

  2. How likely are you to recommend the clinic to friends or family?Single choice

  3. What is one thing the clinic should keep doing?Long text

  4. What is one thing the clinic should change?Long text

  5. Age groupDropdown

  6. Do you identify as having a disability?Single choice

    Optional demographic used to check experience is equal across groups.

  7. Main language spoken at homeDropdown

  8. Would you like someone to contact you about your feedback?Single choice

  9. Anything else?Long text

Which questions to make required

Three are required: the appointment type, the clinician experience grid and overall satisfaction. The appointment type lets results be compared fairly, the grid holds the questions a clinic can act on, and the overall score is the trend line. A required matrix counts as answered once any one row is answered, so the clinic should check grid completeness when analysing. Everything else stays optional so patients can skip what does not apply.

The form built from these questions

A static copy of the finished form, from its own example page.

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Please do not type your name, Medicare number or details about your health anywhere in this survey. Answers are stored without any link to your patient record.

What kind of appointment was it? *

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Three ways to change this bank

For an allied health practice such as physiotherapy, add whether exercises were explained and whether the patient felt progress. For a telehealth service, replace the waiting room questions with connection quality and whether the clinician could see and hear clearly. For a hospital outpatient clinic, add questions about directions and parking, which often drive complaints more than the consultation itself. In every version, keep the experience grid wording fixed between survey rounds, and report each row on its own, because one weak row, such as explaining costs, is easier to fix than a low overall score.

Questions people ask

Should patient satisfaction surveys be anonymous?

Usually yes. Patients give more honest answers when they know the clinic cannot link feedback to their file. Offer a separate optional question asking whether they want to be contacted, and only then ask for details. Keep any contact details apart from the anonymous answers when analysing.

When should a patient satisfaction survey be sent?

Within a day or two of the visit, while the experience is fresh. A link by text message after the appointment works well for many clinics. Avoid surveying the same patient after every visit; once every few months is plenty for regular patients.

Why ask about specific experiences instead of satisfaction?

Satisfaction is shaped by expectations and mood, so it moves for reasons a clinic cannot control. Questions about whether the clinician listened or explained clearly describe experiences the clinic can improve. Established patient experience surveys, such as the CAHPS family, are built around these experience questions.

How do you get more patients to respond?

Keep it short, say how long it takes, send it soon after the visit and explain what the clinic does with answers. A sign in the waiting room saying what changed because of feedback encourages the next round. Offer large text and other languages where your patients need them.

Can a patient survey include health questions?

Keep satisfaction surveys about the experience, not the condition. Health information is sensitive and adds privacy obligations. If you need outcome measures, such as pain or function, use a separate validated tool and explain how the answers will be used and stored.

Who should see patient feedback?

Practice managers and clinicians, in summary form, with comments about individual staff handled privately. Share themes with the whole team. Serious concerns, such as safety issues, need a separate path to a senior person straight away rather than waiting for the monthly report.

How do you compare results over time?

Ask the same questions, the same way, at the same point after visits, and report each experience question separately as well as overall. Split by appointment type. Changes of a few points between months are often noise, so look for consistent movement over several months.

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On writing the questions themselves, read Anonymous survey best practices. For everything the builder can do, see the form maker. Step by step: Create a conversational form with AI, then View, export and manage your responses.

Sources

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