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Patient Experience Survey - Free Healthcare Template | ZenBuild | ZenBuild

Templates→Healthcare→Patient Experience Survey

Patient Experience Survey

Gather patient feedback on their experience with a healthcare provider, facility, or care team. Captures satisfaction with communication, wait times, and overall care quality. Supports HCAHPS compliance and continuous quality improvement.

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Template Details

CategoryHealthcare

IndustryHealthcare

Fields6

Uses0

Views5

healthcarepatient experiencesatisfactionHCAHPSquality

Patient Experience Survey — Form Fields

This healthcare template includes 6 fields. Gather patient feedback on their experience with a healthcare provider, facility, or care team. Captures satisfaction with communication, wait times, and overall care quality. Supports HCAHPS compliance and continuous quality improvement. Free to customize and use on ZenBuild.

Type of Visit (dropdown selection, required) — options: Primary care visit, Specialist appointment, Emergency / Urgent care, Telehealth visit, Inpatient / Hospital stay
How clearly did the care team explain things to you? (rating, required)
How satisfied are you with your overall care? (rating, required)
How long did you wait before being seen? (multiple choice, required) — options: Under 15 minutes, 15–30 minutes, 30–60 minutes, Over 60 minutes
Would you recommend this provider / facility to others? (multiple choice, required) — options: Definitely yes, Probably yes, Probably no, Definitely no
Additional Comments (long text, optional)