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Patient satisfaction survey template

Hear how the visit went, from booking to the way out

Eight questions for the day of the visit: how booking and the wait went, how the staff treated patients and whether they left knowing what comes next. Use it as it is or change any question, and Usertick reads every written answer for you.

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What this patient satisfaction survey tells you

A patient satisfaction survey asks about everything around the care: getting the appointment, the wait, the people at the front desk and in the exam room, and whether the patient left with answers. This template takes about two minutes and stays with the experience of the visit, so patients rate how they were looked after without describing their health.

It is written for the evening of the visit, sent by Usertick email to the patients seen that day while the wait and the conversation are fresh. The same survey runs as a link or a QR code on the after-visit summary or at the checkout desk.

The written answer at the end is read as it arrives and filed under a category from your list, such as waiting times, with a type and an urgency. Results compares satisfaction and the recommend score with the period before, and the matrix shows which part of the visit scores lowest.

In an emailAs a linkOn your websiteAs a conversation
Questions
8
Time to answer
About 2 minutes
Written for
The evening of the visit, by email to the patients seen that day
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, with the first question inside the email. A tap on an answer opens the rest of the survey with that answer already kept. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 8 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 8 · Stars

Overall, how satisfied are you with your visit today?

Why ask it
One overall score up front gives you a number to follow month to month before the detail questions start. A 5-point scale from very dissatisfied to very satisfied is quick to answer on a phone.
What you learn
Results shows the average, a bar per rating and the share who rated 4 or 5, against the period before. Select the 1s and 2s to narrow the page to those patients and read what they wrote at the end.
Make it yours
Keep it first: in the email, patients tap their rating inside the message and the rest of the survey opens with it kept.
Question 2 of 8 · Matrix · Optional

How would you rate the following?

Why ask it
The overall score says how the visit felt; these eight rows say where it went right or wrong, from booking to the provider, the staff and the building.
What you learn
A heat map per row with row averages, so the weakest part of the visit stands out, such as choice of appointment times scoring well below courtesy of the front desk.
Make it yours
Cut the rows that don't apply to your practice and add a Not applicable column, which Results leaves out of the averages, for patients who never saw a nurse.
Question 3 of 8 · Multiple choice

How long did you wait past your appointment time?

Why ask it
The wait past the booked time is one of the things patients remember longest. Patients who pick I was seen on time skip the delay question and go straight to question 5.
What you learn
A donut with the share and count of each band, compared with the period before. Select More than 30 minutes to see how those patients rated the rest of the visit.
Make it yours
Set the bands to your own schedule, such as a 10-minute band for a practice that books short slots.
Question 4 of 8 · Yes / No

Were you told about the delay?

Why ask it
Only patients who waited see it. A delay someone explained is easier to accept than one nobody mentioned.
What you learn
The share that said yes among the patients who waited, against the period before, so you can see whether the team speaks up when the schedule runs late.
Make it yours
Agree on what the front desk says when the provider runs late, then watch this share in the weeks after.
Question 5 of 8 · Yes / No

Did you leave with answers to all your questions?

Why ask it
A patient who leaves with an open question may call back or book again to ask it. The question measures the conversation without asking what the conversation was about.
What you learn
The share that said yes. Select No to see whether those patients also rated listening or time with the provider lower in the matrix.
Make it yours
To compare providers, run one survey per provider or add a Dropdown that names the provider, since Results doesn't split answers by the tag on a link.
Question 6 of 8 · Yes / No

Do you know what to do next, such as a follow-up visit or medication?

Why ask it
Next steps, such as a follow-up visit or picking up medication, are where care can slip once the patient leaves. A No is something a printed summary or a call the next day can fix.
What you learn
The share that said yes, compared with the period before. Select No to narrow the page to those patients and read their written answers.
Make it yours
Keep the examples in the label general, so the answer stays yes or no and patients don't start describing their treatment.
Question 7 of 8 · NPS

How likely are you to recommend this practice to friends or family?

Why ask it
The recommend question measures loyalty to the practice as a whole, which shapes where patients book next time.
What you learn
The NPS score, promoters at 9 or 10 minus detractors at 0 to 6, with a bar of detractors, passives and promoters, the score per device and the score line over time.
Make it yours
Read the score line over several months, since a small practice gets only a few answers a week.
Question 8 of 8 · Text · Optional

Is there anything we could do better next time?

Why ask it
The last question collects what the scales missed, in the patient's own words, from parking to the phone line.
What you learn
Each answer with its sentiment and theme, filterable by theme, with up to 8 themes and their trends. Usertick also marks each one as a complaint, an idea or praise and flags the urgent ones.
Make it yours
Keep it optional, and use the placeholder to ask patients to leave out symptoms and treatment details.

What the answers show

Results turns each question into numbers you can follow week by week.

Overall, how satisfied are you with your visit today?

The average rating and the share who gave 4 or 5 stars, against the period before.

How long did you wait past your appointment time?

The share of each answer with its count. Select an answer to narrow the whole page to those people and read what else they said.

How would you rate the following?

Each row's answers side by side, so the part that needs work stands out.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Appointment experience in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Send it the same evening

    Send the survey to the day's patients after the last appointment, or schedule the send ahead of time. Usertick doesn't send on its own when a visit is checked out in your scheduling system.

  2. 02

    Keep the survey about the visit

    Ask about booking, the wait, the staff and the building, and leave diagnoses and treatment out. Usertick's terms don't allow health records or medical details in surveys, and Usertick doesn't sign business associate agreements.

  3. 03

    Ask returning patients again

    Skip people who already received this survey is on by default. Turn it off when a patient who comes back next month should be asked about that visit too.

  4. 04

    Fix the lowest row first

    Each month, pick the matrix row with the lowest average, change one thing, and watch that row against the period before.

CSAT surveysPatient satisfaction surveysEmail surveysUrgent care visits questions

More satisfaction templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

Browse all templates
CSATPharmacy visitLearn how customers rated a pharmacy visit, the wait and how clearly the medicine was explained. Share it on the receipt with a QR code.
CSATDental visitLearn how patients rated their dental visit, from comfort in the chair to how clearly costs were explained. Send it the same day.
CSATPhysical therapy sessionCheck how patients feel after a session and whether their home exercises and treatment plan are clear. Send it an hour after each session.
CSATEmergency visitLearn how patients experienced an emergency visit: waiting, respect, pain management and discharge. Send it two days after discharge.

Questions from the library

Browse the question library
  1. How many hours were you there in total?Ruler · Urgent care visits
  2. How did you decide to come in?Multiple choice · Urgent care visits
  3. Were you told how long the wait would be?Yes / No · Urgent care visits
  4. How would you rate your dentist?Stars · Dental care
  5. How long since your last checkup?Dropdown · Dental care
  6. Were you told the cost before the work started?Yes / No · Dental care

Frequently asked questions

On the day of the visit, ideally that evening, while the wait and the conversation are fresh. Usertick sends the email now or at a time you schedule up to 30 days ahead.

Enough to cover the whole visit and few enough to finish on a phone. This template asks eight and takes about two minutes, and patients seen on time skip the delay question.

Yes, by link or QR code. Turn on anonymous responses and share the link on the after-visit summary or a sign at checkout; a survey sent through Usertick email stays tied to each patient's contact.

Symptoms, diagnoses, medication and anything else from their health record. Usertick's terms don't allow medical details in surveys, so say so in the placeholder of the open question.

Read the written answer first, then the matrix rows rated Poor or Fair. Give the response an owner in the inbox, and a workflow can post every rating of 1 or 2 to Slack or Microsoft Teams.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

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