Appointment Experience Survey
Wait against appointment time, reception privacy, and whether the next step got booked.
6 questions · 1 page · about 2 minutes to answer · fully editable after you start
Patients forgive a busy clinic; they do not forgive being kept in the dark. This post-appointment survey measures the visit against the promise it made – how far past the booked time the patient was actually seen, and whether anyone acknowledged the delay – because an unexplained forty minutes damages trust more than an explained hour.
It also covers two things clinics rarely audit: whether conversations at the reception desk could be overheard by the waiting room, and whether the patient left with the follow-up actually booked rather than a vague instruction to call back. Both are quiet sources of complaints, and both are fixed by process rather than by clinical time.
Template preview
This is a picture of every question as a respondent would see it, so nothing on it can be clicked or typed into. Use this template to get your own editable copy.
Opens in the Light theme, or in your own default theme if you have set one — change it anytime to any of the 4 built-in looks, or build your own on a paid plan.
Page 1
Your recent appointment
This survey is about your recent appointment. Tell us how the wait, the reception desk and the visit itself went, and whether your next step was arranged, so we can improve the experience for everyone who comes in. It takes about 2 minutes. This form is not an emergency service. If you need urgent medical help, call your local emergency number.
Q1.How would you rate each part of your visit?*
| Poor | Fair | Good | Excellent | Not applicable | |
|---|---|---|---|---|---|
| Being listened to without feeling rushed | |||||
| Clarity of explanations | |||||
| Reception and admin staff | |||||
| Comfort of the waiting area |
Q2.How long after your booked time were you actually seen?*
- On time or early
- Up to 15 minutes late
- 16 to 45 minutes late
- Over 45 minutes late
- I did not have a booked time
Q3.If you were kept waiting, did anyone tell you why?*
- Yes - and I was updated
- Only when I asked
- No one said anything
- I was not kept waiting
Q4.Could your conversation at the reception desk be overheard from the waiting area?*
- No - it felt private
- Possibly
- Yes - and I didn't mind
- Yes - and it bothered me
- I did not speak with reception
Q5.Did you leave with your next step actually arranged?*
- Yes - follow-up booked before I left
- I was told to call back and book it
- Nothing further was needed
- I am still unsure what happens next
Q6.What would have made today's visit easier for you?
Where this template is used
More Healthcare & Wellness templates
Browse all Healthcare & Wellness templates
Caregiver Support Survey
Check on the people doing the caring: burden, respite, and what support would help.
Chronic Care Monthly Check-in
Between appointments: symptoms, self-management confidence, and what changed.
Clinic Waiting Time Survey
Measure perceived versus scheduled waits and what would make waiting easier.