Patient Experience & Satisfaction Survey (NPS + CSAT)

Welcome, and thank you for considering this survey. This brief questionnaire takes approximately 5 minutes and asks about your recent healthcare visit—including scheduling, provider interaction, and any technology you used. Your participation is entirely voluntary, and you may stop at any time. All responses are confidential, reported only in aggregate, and used solely for quality improvement purposes. There are no right or wrong answers; we simply value your honest opinions.

When was your most recent visit with this clinic or provider?

• Within the last 7 days
• 1–4 weeks ago
• 1–3 months ago
• More than 3 months ago
• Not sure

How did you schedule or request this visit? Select all that apply.

• Phone call
• Online patient portal
• Clinic website
• Walk-in
• Referral from another provider
• Mobile app
• Other

The following questions ask about the clinician you saw during this visit. Please indicate your level of agreement with each statement.

Which of the following technologies, if any, were part of this visit? Select all that apply.

• None
• Telehealth video
• Patient portal/app (forms, messages)
• Remote monitoring device
• Kiosk or check-in tablet
• Automated phone/SMS reminders
• Other

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

What is your age?

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

Thank you for completing this survey. Your feedback is valuable and will be used to improve the quality of care and access at this clinic. If you have any questions or concerns, please contact [clinic contact information].

What type of visit was it?

• In-person visit
• Video/telehealth
• Phone consult
• Messaging/portal only

How easy was it to schedule your appointment?

My clinician listened carefully to my concerns.

Overall, how reliable was the technology you used during this visit?

Based on your responses in this survey, is there anything else you would like to share about your experience with access, provider interaction, or technology during this visit?

Which gender do you identify with?

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

Which best describes the service you received?

• Primary care
• Specialist
• Urgent care
• Diagnostic/imaging
• Therapy/behavioral health
• Other

Approximately how long did you wait past your scheduled appointment time?

• No wait or not applicable
• 1–10 minutes
• 11–20 minutes
• 21–30 minutes
• 31–60 minutes
• More than 60 minutes

My clinician explained my condition and treatment options clearly.

If you experienced any technical issues during this visit, please briefly describe what happened.

We'd like to learn a bit more about your visit experience. An AI moderator will ask you a couple of brief follow-up questions based on your responses.

Approximately how many healthcare visits have you had in the past 12 months?

• 0 (this was my first)
• 1–2
• 3–5
• 6–10
• More than 10
• Prefer not to say

If scheduling was difficult, what specifically made it hard?

My clinician treated me with courtesy and respect.

My clinician spent enough time with me during the visit.

Overall, how would you rate the quality of care you received during this visit?