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Physician Practice Patient Experience Survey

Captures how patients experience a physician practice end-to-end — scheduling ease, wait times, physician communication, and likelihood to recommend — with an AI follow-up that digs into the 'why' behind recommendation scores, especially from patients who were lukewarm or dissatisfied. Built for practice managers and physician groups tracking patient experience.

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Sample questions

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

12 questions · ~7 min
Q01
Message

Thanks for taking a few minutes to tell us about your recent visit to (Replace with practice name). Your feedback helps the practice improve care and service. This will take about 7 minutes.

Q02
Multiple ChoiceRequired

What best describes your most recent visit to this practice?

  • New patient visit
  • Follow-up or routine visit
  • Urgent or same-day visit
  • Telehealth visit
Q03
Opinion ScaleRequired

How easy was it to schedule this appointment?

Scale: 1 – 5
Min:Very difficultMax:Very easy
Q04
Rating ScaleRequired

How would you rate the wait time at your appointment, from checking in to being seen?

Range: 1 – 5
Min:Very poorMax:Excellent
Q05
MatrixRequired

Thinking about your interaction with the physician, how much do you agree with each statement?

4 rows × 5 columns
  • The physician listened carefully to my concerns
  • The physician explained things in a way I could understand
  • I had enough time to ask questions
  • Staff treated me with courtesy and respect
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q06
Opinion ScaleRequired

How likely are you to recommend this practice to a friend or family member?

Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q07
AI Interview

Probe the reasoning behind the respondent's recommendation score, anchoring on their specific visit. If the score was low or middling (6 or below), find out precisely where the experience broke down — scheduling, wait time, physician communication, or staff interaction — and what would have changed the score. If the score was high, identify the single moment that made the visit stand out. Always try to surface one concrete, actionable detail rather than a general impression.

Q08
Multiple Choice

In the last 12 months, how many times have you visited this practice?

  • This was my first visit
  • 2-3 times
  • 4-6 times
  • More than 6 times
Q09
Long Text

What is the one thing this practice could do to improve your experience?

Q10
Multiple Choice

Which age range best describes you?

  • Under 18
  • 18-34
  • 35-49
  • 50-64
  • 65 or older
Q11
Multiple Choice

What type of insurance coverage did you use for this visit?

  • Private/employer insurance
  • Medicare
  • Medicaid
  • Self-pay
  • Other
Q12
Message

That's everything — thank you for sharing your experience. Your answers will be reviewed by practice leadership to improve scheduling, wait times, and patient communication.

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.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Includes a dedicated AI follow-up interview that probes the reasoning behind each respondent's recommendation score, digging deeper with lukewarm or dissatisfied patients specifically
  • Combines structured metrics (scheduling ease, wait time rating, physician communication matrix, recommendation likelihood) with open-ended improvement feedback in one flow
  • Captures visit context (visit type, visit frequency in last 12 months, insurance type, age range) so practice managers can segment experience data by patient profile
  • Uses conversational chat-style intro and closing messages to keep the survey approachable rather than feeling like a clinical intake form

QuestionPro

Physician Practices Survey Template

A genuinely comparable static survey template aimed at capturing patient experience at physician practices. It appears to cover similar ground (visit experience, satisfaction) but as a fixed-question form rather than an adaptive interview. Good for basic benchmarking but likely requires manual follow-up analysis to understand the 'why' behind low scores.

What it does well

  • Purpose-built for physician practice patient feedback, so questions are likely industry-relevant out of the box
  • Backed by QuestionPro's broader survey platform, including standard reporting and distribution tools
  • Likely quick to deploy for teams wanting a straightforward, no-frills patient experience survey

Where it falls short

  • Static question set with no adaptive AI follow-up to explore reasoning behind low or lukewarm recommendation scores
  • No indication of automated per-response quality scoring or transparent prompt methodology
  • No voice AI interview or guided screen-share task option for richer qualitative capture

Ready to launch?

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

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