Patient Satisfaction Survey

Ask your patients how you did — and hear the answer.

This editable survey collects patient feedback on scheduling, communication, service, and experience — with room for what went well and what could improve.

What's included

• Editable Word document (DOCX) — customize it for your practice
• Sections, each with completion checkbox, date/initials, and notes: Overall Experience · Scheduling · Check-In · Communication · Courtesy / Professionalism · Wait Time · Facility Experience · Clarity of Information · Likelihood to Recommend · What Went Well? · What Could Improve? · Additional Comments
• Office/practice header section (office/practice, date, prepared by, status)
• Notes section for office-specific requirements

How it works

1. Purchase and download instantly — your file is ready right after checkout
2. Open in Word or Google Docs and make it yours
3. Print what you need, keep the rest digital

Designed as an organizational resource for medical offices and healthcare practices. Customize it to fit your practice's procedures and applicable requirements.