Patient Satisfaction Survey

Patient Satisfaction Survey — Form Fields

This healthcare template includes 8 fields. Measures patient satisfaction with care quality, staff, and overall clinic experience. Free to customize and use on ZenBuild.

• Date of Visit (text, required)
• Overall satisfaction with your visit (rating, required)
• Satisfaction with wait time (rating, required)
• Satisfaction with staff friendliness (rating, required)
• Satisfaction with provider communication (rating, required)
• Were your concerns fully addressed during the visit? (multiple choice, required) — options: Yes, Partially, No
• Would you recommend us to family or friends? (multiple choice, required) — options: Yes, Maybe, No
• Additional feedback or suggestions (long text, optional)