Secret Santa Questionnaire: 30 Questions to Send Before the Draw Free survey template
Patient satisfaction survey template. Thirteen questions about the visit, none about health.
Ask patients how easy it was to book, how long they waited, how the reception staff treated them, whether the doctor listened and explained things clearly, and how clean the clinic was. An NPS question with its own follow-up for each group and one choice of what to fix first turn the answers into a plan. The survey asks nothing about diagnosis, symptoms or treatment.
Free plan: 100 responses a month and up to 50 surveys, no credit card. Every question works on the Free plan, the NPS question with its follow-ups included. The report calculates the score for you.
The template’s real survey on a phone.
- 13 ready questionsAbout 3 min on a phone.
- Yours to changeQuestions, answers and logic.
- A ready reportA chart for every closed question.
- Export on every planCSV, Excel and SPSS.
Patients judge a clinic by the phone call, the waiting room and the minutes with the doctor. Ask about all three.
The 13 patient satisfaction survey questions in this template.
In the order patients see them. None of them asks about health, and you can change any question.
Booking and waiting
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Was this your first visit to [Clinic]?
Why ask it. New and returning patients notice different things. Compare their answers to see whether the first impression or the routine needs work.
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How easy was it to book your appointment?
Why ask it. Booking is the first contact with the clinic. The last option keeps walk-in patients from rating a step they skipped.
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How long did you wait before you were seen?
Why ask it. The note under the question tells patients to count from their appointment time, or from arrival if they came without one. Ranges are quick to answer and easy to chart.
The staff and the doctor
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How would you rate the courtesy of the reception staff?
Why ask it. Reception sets the tone for the whole visit. Stars are the quickest answer, and the average is easy to track month by month.
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Did the doctor listen carefully to you?
Why ask it. Whether the doctor listened shapes how patients judge the whole visit. Four plain answers read more easily than a numeric scale.
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Did the doctor explain things in a way you could understand?
Why ask it. It asks how things were explained, not what the patient was told, so no medical details end up in the answers.
The clinic and the visit
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How would you rate the cleanliness of the waiting area and rooms?
Why ask it. Patients notice a clean waiting room the moment they walk in. Stars keep the answer to one tap.
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Overall, how satisfied are you with your visit?
Why ask it. One overall score to track from month to month. Read it next to the questions before it to see what moves it.
Recommendation and what to fix
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How likely are you to recommend [Clinic] to friends or family?
Then one open question, depending on the score:
Why ask it. The standard Net Promoter Score question, worded for friends and family. The follow-up appears under the scale once a score is picked, worded for the patient’s group, so every score comes with its reason.
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What should we improve first?
Why ask it. One answer only, so patients have to choose. Read it next to the score: what detractors pick most is your first fix.
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Is there anything else you'd like to tell us?
Why ask it. Room for anything the questions missed. The placeholder asks patients not to include medical details.
Optional contact
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May we contact you about your feedback?
Why ask it. A call back shows an unhappy patient that the clinic listened. No ends the survey here.
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Your phone number
Why ask it. Asked only of patients who said yes, so you know whom to call.
How to run a patient satisfaction survey from this template.
- 1
Copy the template
Click “Use this template” and create a free account or log in. The survey is copied to your account with all 13 questions, the three NPS follow-ups and the logic. The copy waits in your survey list as a draft.
- 2
Put in your clinic name
Replace [Clinic] with your clinic’s name in the questions and on the welcome screen. If patients see a dentist or a therapist, change “doctor” in questions five, six and ten.
- 3
Send it after the visit
Paste the link into your follow-up e-mail or message the same day, embed the survey on your site, or print the QR code for the reception desk so patients can answer on the way out.
- 4
Read the report
Every closed question gets a chart, and the report shows your Net Promoter Score with the share of detractors, passives and promoters. Each NPS answer shows the score with the patient’s reason under it.
How to read patient satisfaction survey results.
Where the visit goes wrong
Put the answers on booking, waiting, reception, the doctor and cleanliness side by side. The step with the most low answers is where patients lose patience.
The score and its reasons
NPS is the share of promoters (9–10) minus the share of detractors (0–6). Read the detractors’ reasons first and group them into a few themes. The theme that matches what they chose to improve first is where to start.
New and returning patients
On Basic and higher plans, filter the answers by the first question or by score to compare groups. Export everything to Excel, CSV or SPSS on any plan.
How to get honest answers from patients.
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Ask the same day
Send the link within a few hours of the visit, while the wait and the conversation are still fresh.
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Keep health out of it
The survey is about the service. Do not add questions about diagnosis or treatment, and keep the line on the welcome screen that asks patients not to write medical details.
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Call back the unhappy ones
Turn on e-mail notifications to see each new answer as it comes in. Call patients who gave a low score and left their number within a day or two.
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Show what changed
Tell patients about one thing you fixed because of their answers, on a sign at reception or in your next newsletter. They answer the next survey more willingly.
More patient satisfaction questions you can add.
Not in the template. Add any of them in the builder in a few clicks.
Booking and access
- How did you book your appointment?
- Was the appointment time convenient for you?
- How easy was it to find the clinic and park?
Communication
- Did you get a reminder before your appointment?
- Did the staff tell you how long you would have to wait?
- Were you told clearly what to do after the visit?
Prices and paperwork
- How clear was the information about prices?
- How easy was the paperwork at check-in?
- How easy was it to pay?
Free tools for your results
- NPS calculatorEnter the counts of each score and get the Net Promoter Score with the three groups.
- CSAT calculatorThe share of satisfied patients from the overall satisfaction question.
- Rating average calculatorThe average and spread of the 1–5 star ratings for reception and cleanliness.
- Surveys for medical clinicsHow clinics collect patient feedback with SurveyNinja, from the QR code at reception to the report.
- Surveys for hospitalsPatient experience surveys for hospital departments and outpatient services.
- NPS surveys in SurveyNinjaThe NPS question, the follow-ups and the report with the score and its groups.
More templates
Questions about this template
What questions should a patient satisfaction survey ask?
Ask about each step of the visit: booking, the wait, the reception staff, how the doctor listened and explained things, and cleanliness. Then ask for an overall score, whether the patient would recommend the clinic and what to improve first. This template asks all of it in 13 questions, with an optional contact at the end.
Does the survey ask about the patient’s health?
No. It asks about the service only, with no questions about diagnosis, symptoms, treatment or medication. The welcome screen and the open question ask patients not to write medical details. Keep any question you add about the visit, not the condition.
Can I use it for a dental, physiotherapy or other practice?
Yes. Replace [Clinic] with your practice’s name and change “doctor” to dentist, therapist or whoever your patients see. The other questions fit any outpatient visit.
How do I send it to patients after the visit?
Paste the link into your follow-up e-mail or message, embed the survey on your site, or print the QR code for the reception desk. Patients answer on their phone in about three minutes.
Is the patient satisfaction survey free?
Yes. Every question in this template, the NPS question with its follow-ups included, works on the Free plan, and the report calculates the score on every plan.
Find out how patients feel about their visit.
Copy the survey, put in your clinic name and send the link after today’s appointments.