Patient Satisfaction Survey Template: Wait Times & Access
Patient satisfaction survey template to collect feedback fast. Measure wait times, counseling quality, and appointment access. Customizable and ready to use.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Template Overview
23
Questions
AI-Powered
Smart Analysis
Ready-to-Use
Launch in Minutes
This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.
Sample Survey Items
Q1
Date
When was your most recent visit to this facility?
Q2
Dropdown
What type of visit was it?
Primary care
Specialist
Urgent care
Emergency department (ED)
Telehealth/virtual visit
Lab or imaging only
Pharmacy or medication counseling
Other
Q3
Numeric
About how many minutes did you wait from arrival/check-in until you were seen by a clinician?
Accepts a numeric value
Whole numbers only
Q4
Numeric
After the visit ended, how many minutes did you wait for any follow-up steps (for example, labs, pharmacy, or discharge)?
Accepts a numeric value
Whole numbers only
Q5
Opinion Scale
Overall, how reasonable was your total time waiting during this visit?
Range: 1 – 10
Min: Very unreasonableMid: NeutralMax: Very reasonable
Q6
Rating
How easy was it to get an appointment when you needed it?
Scale: 11 (star)
Min: Very difficultMax: Very easy
Q7
Matrix
Please rate your agreement with the following statements about access and availability.
Rows
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Clinic hours fit my schedule
•
•
•
•
•
Same-day or next-day appointments were available
•
•
•
•
•
Staff responded to calls or messages promptly
•
•
•
•
•
Appointment reminders were helpful
•
•
•
•
•
Telehealth was available when appropriate
•
•
•
•
•
Q8
Multiple Choice
Which methods did you use to book this visit? Select all that apply.
Phone call
Website or patient portal
Mobile app
Walk-in (no appointment)
Referral scheduled by another clinic
Other
Q9
Multiple Choice
Attention check: To show you are paying attention, please select "I am paying attention."
I am paying attention
I am not paying attention
Prefer not to say
Q10
Opinion Scale
How clear were the clinician’s explanations about your condition and care plan?
Range: 1 – 10
Min: Not clear at allMid: Somewhat clearMax: Extremely clear
Q11
Multiple Choice
Did the clinician involve you in decisions to the extent you wanted?
Yes, completely
Yes, somewhat
Not really
Not at all
Not applicable
Q12
Ranking
Rank the aspects of counseling that mattered most in this visit (drag to order).
Drag to order (top = most important)
Clear next steps and follow-up
Risks and benefits explained
Medication instructions
Lifestyle or self-care guidance
Time to ask questions
Q13
Rating
After the visit, how confident did you feel about managing your care?
Scale: 11 (star)
Min: Not at all confidentMax: Very confident
Q14
Opinion Scale
Overall, how satisfied were you with this visit?
Range: 1 – 10
Min: Not at all satisfiedMax: Very satisfied
Q15
Dropdown
What is your age group?
18-24
25-34
35-44
45-54
55-64
65 or older
Prefer not to say
Q16
Multiple Choice
Which best describes your gender?
Woman
Man
Non-binary
Prefer not to say
Q17
Dropdown
Where do you live?
Africa
Asia
Europe
Middle East
North America
Oceania
South America
Prefer not to say
Q18
Dropdown
What is the highest level of education you have completed?
High school or less
Some college or associate degree
Bachelor's degree
Graduate or professional degree
Prefer not to say
Q19
Multiple Choice
What is your current employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed, looking for work
Unemployed, not looking for work
Student
Retired
Unable to work
Prefer not to say
Q20
Long Text
What is one thing we could do to improve your experience?
Max 600 chars
Q21
AI Interview
AI Interview: 2 Follow-up Questions on Your Visit
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Q22
Chat Message
Thank you for your time—your feedback helps improve care.
Q23
Chat Message
Welcome! This brief survey asks about one recent healthcare visit. It takes about 3-5 minutes. Please answer based on your most recent visit.
Frequently Asked Questions
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