Q01
Message
All templatesIndustry-Specific
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.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
12 questions · ~7 min
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 TemplateA 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
Frequently asked questions
What questions are in the “Physician Practice Patient Experience Survey” template?
The template includes 12 ready-to-use questions, starting with: “Thanks for taking a few minutes to tell us about your recent visit to (Replace with practice name). Your feedback helps…” · “What best describes your most recent visit to this practice?” · “How easy was it to schedule this appointment?”. The full set is previewed above, and every question is editable.
How long does this survey take to complete?
Respondents typically finish the 12 questions in about 7 minutes.
Can I customize this template?
Yes — every question, answer option, and the ordering is editable before you launch. You can add or remove questions, or ask the AI editor to rework the survey around your research goal.
Is this template free to use?
Yes. Open it in the editor and start customizing right away — no account required to try it, and the free plan covers launching your survey.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
Related templates
More studies on similar topics.
Industry-Specific
Energy Drink Habits, Brand Choice & Pricing Survey
Measures how often people drink energy drinks, which brands and formats they choose, what drives that choice, and what they'd pay for a new product. Built for beverage brand and category teams, with an AI follow-up interview that reconstructs the real story behind a recent brand switch or purchase decision instead of relying on stated preference alone.
View templateIndustry-Specific
Patient Visit Experience & Care Feedback Survey
Captures how patients experienced a recent visit — wait times, communication, staff respect, and overall likelihood to recommend — with a best-worst prioritization of improvement areas and an AI follow-up that digs into the specific moment behind their recommendation score. Built for clinics, hospitals, and practice managers tracking care quality.
View templateIndustry-Specific
Dental Patient Experience & Satisfaction Survey
Measures how patients experience each stage of a dental visit — booking, wait times, pain management, cost transparency, and trust in the dentist — and what drives their willingness to recommend the practice. Built for dental practices and group practices benchmarking patient experience, with an AI follow-up that uncovers the real story behind low or high recommendation scores, especially around anxiety and trust.
View templateIndustry-Specific
Medical Examination & Check-Up Experience Survey
Captures how patients experience scheduling, wait times, communication, and results delivery during routine or diagnostic medical exams. Includes a best-worst trade-off to prioritize service improvements and an AI follow-up interview that reconstructs what actually happened during the visit — especially around how results were explained — rather than just a satisfaction score.
View templateIndustry-Specific
Patient Experience Survey: Access, Communication & Care Quality
Measures patient satisfaction across appointment access, provider communication, follow-up timeliness, and digital touchpoints for healthcare organizations seeking actionable improvement insights and NPS benchmarking.
View templateIndustry-Specific
Patient Visit Satisfaction & Communication Survey
Assesses patient experience across scheduling access, clinician communication, post-visit follow-up, and overall satisfaction to identify actionable care quality improvements.
View template