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Patient Scheduling & Reminder Satisfaction Survey

Evaluates patient satisfaction with healthcare appointment booking, confirmation, and reminder processes to identify friction points, optimize communication timing, and reduce no-show rates.

Sample questions

A preview of what’s in the template. Every question is editable before you launch.

19 questions · ~9 min
Q01
Message

Welcome to this survey about your healthcare appointment scheduling experience. Your participation is voluntary and you may stop at any time. All responses are confidential and will be reported only in aggregate — no individual answers will be shared. There are no right or wrong answers; we are simply interested in your honest opinions. This survey takes approximately 5 minutes to complete. Please think about your most recent healthcare appointment within the last 6 months as you answer the following questions.

Q02
Multiple Choice

Have you had a healthcare appointment (in-person or telehealth) within the last 6 months?

  • Yes
  • No
Q03
Multiple Choice

How did you book your most recent healthcare appointment?

  • Phone call to the clinic
  • Central scheduling phone line
  • Online patient portal
  • Provider's mobile app
  • Third-party website
  • Walk-in without booking
  • Someone else booked for me
  • Other (please specify)
Q04
Multiple Choice

Which types of reminders did you receive for that appointment? Select all that apply.

  • Text/SMS
  • Email
  • Phone call
  • Mobile app push notification
  • Patient portal message
  • Postal mail
  • I did not receive any reminders
Q05
Opinion Scale

Overall, how satisfied are you with the scheduling and reminder process for your most recent appointment?

Scale: 17
Min:Very dissatisfiedMax:Very satisfied
Q06
Dropdown

What is your age group?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say
Q07
Message

Thank you for completing this survey. Your feedback will help improve appointment scheduling and reminder systems for patients like you.

Q08
Opinion Scale

Overall, how easy or difficult was it to book your appointment?

Scale: 17
Min:Very difficultMax:Very easy
Q09
Opinion Scale

How helpful were the reminders you received in keeping or preparing for your appointment?

Scale: 15
Min:Not at all helpfulMax:Very helpful
Q10
Opinion Scale

How likely are you to recommend this healthcare provider's scheduling system to a friend or family member?

Scale: 17
Min:Very unlikelyMax:Very likely
Q11
Multiple Choice

Which of the following best describes your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q12
Opinion Scale

How easy or difficult was it to find an available time slot that worked for your schedule?

Scale: 17
Min:Very difficultMax:Very easy
Q13
Multiple Choice

When would you most prefer to receive appointment reminders? Select all that apply.

  • Same day (morning of the appointment)
  • 1 day before
  • 2 to 3 days before
  • About 1 week before
  • More than 1 week before
Q14
Long Text

What is one thing that would make scheduling or reminders better for you?

Q15
Multiple Choice

What type of health coverage do you currently have?

  • Private insurance (employer or individual)
  • Public/government plan (e.g., Medicare, Medicaid)
  • None / self-pay
  • Prefer not to say
Q16
Opinion Scale

How easy or difficult was it to select your preferred provider or location?

Scale: 17
Min:Very difficultMax:Very easy
Q17
AI Interview

Based on your responses, we'd like to explore your scheduling and reminder experience in a bit more depth. Please share your thoughts and our AI moderator will ask a couple of follow-up questions.

Q18
Opinion Scale

How easy or difficult was it to confirm your appointment details (date, time, location)?

Scale: 17
Min:Very difficultMax:Very easy
Q19
Multiple Choice

Which of the following, if any, made scheduling your appointment more difficult? Select all that apply.

  • Long hold times on the phone
  • Limited available time slots
  • Patient portal was hard to use
  • Could not find my provider in the system
  • Insurance or authorization confusion
  • Accessibility or language barriers
  • Privacy or security concerns
  • Other (please specify)
  • None of the above

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.