Healthcare & Wellness Survey Templates

Appointment Experience Survey

Wait against appointment time, reception privacy, and whether the next step got booked.

6 questions

Caregiver Support Survey

Check on the people doing the caring: burden, respite, and what support would help.

4 questions

Chronic Care Monthly Check-in

Between appointments: symptoms, self-management confidence, and what changed.

4 questions

Clinic Waiting Time Survey

Measure perceived versus scheduled waits and what would make waiting easier.

4 questions

Clinical Trial Participant Experience

The participant's side of research: consent clarity, burden, and feeling valued.

4 questions

Dental Visit Feedback Survey

Comfort, pain management, cost clarity, and hygiene – the things dental patients remember.

4 questions

Emergency Department Experience Survey

Triage communication, waiting with pain, and dignity under pressure.

4 questions

Eye Care & Optician Visit Survey

Exam thoroughness, honest frame advice, and how the new prescription feels.

4 questions

Health App & Wearable Feedback

Tracking accuracy, habit fit, and whether the data changed any behaviour.

4 questions

Health Plan Member Experience

Coverage clarity, claims, provider access, and the phone call nobody wants to make.

5 questions

Health Risk Screening Questionnaire

Lifestyle screening for wellness programmes: activity, smoking, sleep, and readiness to change.

4 questions

Home Care Visit Feedback

Care in the client's home: punctuality, consistency of carers, and dignity.

4 questions

Hospital Food Service Feedback

Meals as care: temperature, choice, dietary accuracy, and actually eating.

4 questions

Informed Consent Acknowledgement

A structured consent record: understanding confirmed, questions invited, signed and dated.

6 questions

Maternity Care Experience Survey

Antenatal to postnatal: being heard, informed choices, and support after birth.

4 questions

Medication Adherence Survey

Find out honestly whether patients take their medication – and what gets in the way.

4 questions

Mental Health Self Check-in

A private weekly check-in on mood, sleep, energy, and coping – for programmes and practices.

4 questions

New Patient Intake Form

Registration essentials, history highlights, consent, and a signature – before the first visit.

8 questions

Nutrition & Lifestyle Assessment

A dietitian-style intake: eating patterns, goals, and the honest obstacles.

5 questions

Paediatric Visit Parent Feedback

The visit through a parent's eyes: child comfort, communication, and confidence at home.

4 questions

Patient Experience Survey

Track patient satisfaction across appointments and care quality.

12 questions

Pharmacy Service Feedback

Wait, counselling, stock, and privacy at the counter that sees everyone.

4 questions

Physiotherapy Progress Survey

Between-session tracking: pain, function, and home-exercise adherence.

5 questions

Post-Discharge Follow-up Survey

48 hours after discharge: instructions understood, medications collected, warning signs known.

5 questions

Pre-Appointment Symptom Intake

Structured symptom capture before the visit – so the appointment starts at minute one.

5 questions

Quit Smoking Programme Check-in

Weekly cessation support: cravings, slips without shame, and what is working.

5 questions

Sleep Health Assessment

Sleep quantity, quality, daytime impact, and habits – the intake for sleep programmes.

4 questions

Telehealth Visit Feedback

Video-visit quality: connection, privacy comfort, and whether remote care did the job.

4 questions

Therapy Group Session Feedback

Group-based care: safety to share, facilitation, and takeaways that survive the week.

4 questions

Vaccination Clinic Feedback

Flow, wait, information, and aftercare clarity for vaccination drives.

4 questions

Wellness Programme Enrolment Form

Sign-up, goals, health flags, and consent for a workplace wellness programme.

6 questions