Wellness · free template

Patient Satisfaction Survey

Post-visit patient experience survey covering access, communication, care and whether concerns were raised.

A ready-to-use fitness, wellness & coaching form for clinics, coaches and therapists: 28 questions, 4 pages, 4 conditional rules.

Questions: 28
Pages: 4
Layouts: classic · card
Conditional rules: 4
Typical time: 4 min

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Live preview and test console

This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.

Page 1 of 4 — Your visit

Every question on this page is currently visible.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

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.

1Press “Use this template” — a fresh copy of Patient Satisfaction Survey lands in your workspace, ready to edit.
2Rename or delete any question, and change what is required. Nothing here is fixed.
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.
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.
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.

About this template

Patient experience scores drift because practices ask about the doctor and forget everything around them. This survey covers the whole visit. The patient records the type of appointment, the department or clinician seen and how they booked, then rates access first: how easy it was to get an appointment, how long the wait was against what they were told, and how the reception team handled them. The clinical block rates whether the clinician listened, explained things in plain language, involved the patient in decisions and gave clear next steps, plus whether the patient left knowing what happens now — the single question that predicts a follow-up call more than any other. Facilities cover cleanliness, privacy and accessibility. Anyone reporting a problem is asked whether they raised it at the time and whether they want a callback, and asking for one requires contact details so the practice can act instead of guessing. The survey deliberately does not collect clinical detail, so it stays a satisfaction record rather than part of the medical record.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — Your visit

Date of your appointmentrequired
Type of appointmentrequired
Department or clinician seen
How did you book?
Was this your first visit to us?

Page 2 — Getting seen

How easy was it to get an appointment?
How long did you wait past your appointment time?required
Were you told about any delay?
How helpful was the reception team?
How easy was our phone line or online system to use?

Page 3 — Your care

Did the clinician listen to you?
Were things explained in language you understood?
Were you involved in decisions about your care?
Did you have enough time in the appointment?
Did you leave knowing what happens next?required
Cleanliness of the premises
Privacy at reception and in the room
Accessibility of the building
How likely are you to recommend this practice to friends and family?

Page 4 — Anything else

Did anything go wrong during your visit?required
What happened?
Did you raise it at the time?
What did we do well?
What would you change?
Would you like someone to contact you about your visit?required
Your namerequired
Best contact number
Email addressrequired

28 questions in total.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 2 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Did anything go wrong during your visit?”

Reveals questions
If “Did anything go wrong during your visit?” is Yes, the form reveals “What happened?” and “Did you raise it at the time?”.

Driven by “Would you like someone to contact you about your visit?”

Makes answers required
If “Would you like someone to contact you about your visit?” is Yes, “Your name” and “Best contact number” become required before the form can be submitted.

Set it up step by step

1
Send it the same day
Trigger the link from your appointment system a few hours after the visit, while the wait time and the conversation are both still remembered accurately.
2
Keep clinical detail out
The opening note tells patients not to describe symptoms here. That keeps responses out of your clinical record and out of scope for records requests.
3
Alert on callback requests
Notify the practice manager on any response asking for contact, and treat those as complaints under your existing procedure rather than as survey rows.
4
Report access and care separately
Waiting times and phone access have different owners from clinical communication. Split them in the monthly report or you will act on the wrong one.

Mistakes to avoid

Asking one recommend-us question and nothing about access, which is where most complaints actually start.
Letting patients describe symptoms in a free-text box that then sits outside the clinical record.
Collecting callback requests without an alert, so a complaint waits a month for the export.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Acknowledge callback requests within one working day, publish the monthly experience report to the practice team, and take recurring access issues into rota planning.

Works in both layouts

Browse classic templates Browse card templates

Forms that overlap this one

These pages cover the same subject ground as the patient satisfaction survey, matched on the words people actually search for.

Privacy & compliance

This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.

Frequently asked questions

Is this survey a medical record?

It is not intended to be. The form asks about experience only and warns patients not to include clinical detail, so keep it in your feedback system rather than the patient record.

Should responses be anonymous?

Keep name and number optional so honest scores are possible, and require them only when a patient asks for a callback — which this form does automatically.

How often should we survey patients?

Continuously, triggered per appointment, and report monthly. Periodic bulk surveys over-sample the people with the strongest feelings in either direction.

Can we use it for telephone and video appointments?

Yes. Choose the appointment type at the start; the access and care questions apply to remote consultations, and the facilities ratings can simply be left blank.

Patient Satisfaction Survey — is it free?

Yes. You can preview and test Patient Satisfaction Survey on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

Patient Satisfaction Survey — questions included

It asks 28 questions across 4 pages, 8 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Patient Satisfaction Survey — editing and customising

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

Conditional logic in a fitness, wellness & coaching form

4 conditional rules ship with the template: 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. All rules are editable in the Logic tab.

Patient Satisfaction Survey — responses, exports and notifications

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Patient Satisfaction Survey — website embed and sharing

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

More forms teams pair with the patient satisfaction survey.

Related categories

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