Patient Satisfaction Survey 🧑⚕️
Please share your experience with our clinic/hospital. Your feedback helps us improve the quality of care and service. Responses may be anonymous unless you choose to provide contact details.
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What type of visit did you have?
Primary care appointment
Specialist appointment
Urgent care visit
Emergency department visit
Inpatient stay
Diagnostic/lab/imaging
Telehealth/virtual visit
Other
/8
When was your visit?
/8
Overall, how satisfied were you with your care?
1-Very dissatisfied, 5-Very satisfied
/8
How would you rate the clarity of explanations you received about your condition and treatment?
1-Poor, 5-Excellent
/8
Which aspects of your experience were positive? (Select all that apply)
Courtesy/respect from staff
Provider listened to my concerns
Wait time was reasonable
Cleanliness and comfort
Privacy and confidentiality
Clear discharge or follow-up instructions
Billing and administrative process
Other
/8
Which aspects need improvement? (Select all that apply)
Scheduling/appointment availability
Wait time
Communication/explanations
Staff courtesy/professionalism
Facility cleanliness/comfort
Pain management
Discharge/follow-up instructions
Billing/insurance support
Other
/8
What could we do to improve your experience?
/8
If you would like a follow-up, please provide your email address below.
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Thank you for completing our Patient Satisfaction Survey! 💌
We appreciate your feedback and will use it to improve our services.