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Patient Satisfaction Questionnaire

Patient Satisfaction

How long have you been a patient here?

If this is your first visit, how did you hear about us?

Other:

How convenient are we in the following areas?

• Location

• Parking

• Clinic hours

• Availability of staff to help you with your questions

Please let us know what we can do to improve any of these areas.

Was it easy and convenient to get an appointment?

When you last contacted the clinic by phone, were you treated courteously by the staff?

When making your last appointment, did the staff make every effort to suggest a time and day that was convenient for you?

When you come into the clinic, is the staff courteous?

Are you usually seen in a prompt manner?

Please rate us on how genuinely interested we seem to be in you as a person.

During your visits, do you think we adequately answer your questions?

Are you satisfied with the quality of medical treatment you receive from us?

On a scale of 1 to 5, 1 being extremely poor and 5 being excellent, how would you rate your overall experience with our clinic?

What could we do to make the experience better?

If there was one thing you could change about your experience with this clinic, what would it be?

Patient Satisfaction Questionnaire Checklist

Created by: SafetyCulture Staff | Industry: Health Services | Downloads: 71

This patient satisfaction questionnaire can be conducted by medical secretaries or clinic staff to gauge patient satisfaction after a doctor’s consultation or after receiving medical treatment.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

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Patient Satisfaction Questionnaire

Patient Satisfaction

How long have you been a patient here?

If this is your first visit, how did you hear about us?

Other:

How convenient are we in the following areas?

• Location

• Parking

• Clinic hours

• Availability of staff to help you with your questions

Please let us know what we can do to improve any of these areas.

Was it easy and convenient to get an appointment?

When you last contacted the clinic by phone, were you treated courteously by the staff?

When making your last appointment, did the staff make every effort to suggest a time and day that was convenient for you?

When you come into the clinic, is the staff courteous?

Are you usually seen in a prompt manner?

Please rate us on how genuinely interested we seem to be in you as a person.

During your visits, do you think we adequately answer your questions?

Are you satisfied with the quality of medical treatment you receive from us?

On a scale of 1 to 5, 1 being extremely poor and 5 being excellent, how would you rate your overall experience with our clinic?

What could we do to make the experience better?

If there was one thing you could change about your experience with this clinic, what would it be?