Patient Feedback Form Template

✓ No credit card required
✓ No time limit on Free plan

We care about you, and your opinion.Can you briefly describe what type of treatment you've had?How would you rate the following aspects of your experience with us?

Intake

Communication

Treatment

Staff friendliness

How do you feel we could improve our intake process?What do you think we could do better in our communication?Can you briefly explain how you feel we could improve our care? Do you have recommendations on how our staff could do better next time?Is there have any additional feedback you'd like to share on anything we didn't ask about?We're open to hearing it.Please share your thoughts here on further ways we could improve.Thank you for your time and honesty, it really is invaluable to us.

Rated 4.5 out of 600+ reviews on G2.com

Feedback makes everyone better

If you’re looking for an easy way to ask your patients for feedback, you’ve found it. This patient feedback form is easy to fill out and will give you honest, focused answers—because it only asks one question at a time.

Patient feedback form FAQs:

We’ve all been presented with feedback surveys that were the opposite of inviting. With vague or convoluted questions and the robotic feel of more traditional forms, it can be easy for feedback to feel like no more than a box-ticking exercise. Time for a change.

This patient feedback form asks one question at a time and lets you follow up on ratings with deeper questions. Your patients will feel that their feedback is truly being heard, and you’ll learn a lot in the process.

Before you send out your form, there are two things you should do:

Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.

Make it uniquely yours

Customize to your heart's content: backgrounds, Google fonts, colors, buttons, and more.

Choose from thousands of beautiful images, videos, and icons. Or use your own.

Create beautiful forms with zero coding required.

Get started — it's free

Make life easy with integrations

Google Sheets

Salesforce

Slack

Google Analytics

Zapier

HubSpot

Here's what people say about us

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

87% of users reported higher completion rates after switching to Typeform

How does it work?

Make a stylish form in minutes with our intuitive builder.

Choose from different question types: Multiple Choice, Rating, Opinion Scales, and more.

Take respondents down different paths based on their answers.

Patient feedback form not right?

1500+ Templates, 120+ Integrations

Online Order Form Template

Sell products and vouchers online with a custom order form

Learn more

Job Requisition Form Template

Speed up the hiring process with this internal request form for managers

Learn more

Reference Request Form Template

Get the lowdown on candidates with this interactive reference request form

Learn more

monday.com Form Template

Power-up your workflow with our newest integration

Learn more

Lead Generation Form Template

Get more leads—looks great on any device

Learn more

Signup Sheet Template

A fun, friendly way to ask people for information

Learn more

Other categories used by people like you

Order forms Application forms Feedback forms Lead Generation Quizzes Feedback surveys Customer satisfaction surveys File upload forms Evaluation forms Job application forms Marketing surveys Event forms Event surveys

Products

Solutions

Templates

Integrations

Resources & Support

Pricing

Patient Feedback Form Template

Feedback makes everyone better

Patient feedback form FAQs:

How can I help my patients give meaningful and constructive feedback?

What’s the benefit of asking only one question at a time?

What should I consider before using this healthcare form?

Make it uniquely yours

Make life easy with integrations

Here's what people say about us

How does it work?

Patient feedback form not right?

Other categories used by people like you