Patient Satisfaction Survey — shared by the community

Who this template is for

Patient Satisfaction Survey is built for clinics, coaches and therapists who need to collect intake detail and consent before the first session.

• Clinics, coaches and therapists working in fitness, wellness & coaching.
• Teams who need to collect intake detail and consent before the first session without writing code or paying for a custom build.
• Anyone replacing paperwork eating the start of every appointment with one structured record per enquiry.
• Respondents are clients and patients — the form asks them 28 questions across 4 screens.
• Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of paperwork eating the start of every appointment and turns each submission into a record your team can act on immediately.

• 8 questions are required, so submissions arrive complete instead of needing a follow-up email.
• It collects a verified email address so replies and confirmations land.
• It captures a phone number for urgent follow-up.
• It pins the request to a specific date.
• It scores satisfaction on a consistent scale.
• It measures sentiment on a numeric scale.
• Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
• Splitting the form across 4 pages keeps each screen short and shows respondents how much is left.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1. 1Press “Use this template” — a fresh copy of Patient Satisfaction Survey lands in your workspace, ready to edit.
2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

• Features advanced show logic: if “Did anything go wrong during your visit?” is Yes, the form dynamically exposes “What happened?”. Otherwise that question never appears.
• Features advanced show logic: if “Did anything go wrong during your visit?” is Yes, the form dynamically exposes “Did you raise it at the time?”. Otherwise that question never appears.
• Features conditional validation: if “Would you like someone to contact you about your visit?” is Yes, “Your name” becomes mandatory before the form can be sent.
• Features conditional validation: if “Would you like someone to contact you about your visit?” is Yes, “Best contact number” becomes mandatory before the form can be sent.
• All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.