Patient Safety Tool: Sample Patient Satisfaction Survey

MGMA offers a free, downloadable sample patient satisfaction survey.

The sample form was developed in partnership with SullivanLuallin Healthcare Consulting. The survey allows patients to rate line items under the following categories:

•    The appointment
•    The staff
•    Communication with healthcare providers and staff
•    The visit with clinicians
•    The facility
•    Overall satisfaction

The survey also allows space for patients to provide feedback.

Download the sample patient satisfaction survey (PDF) for use in your facility.

Note: View our database providing 150 reports that link to free, downloadable and adaptable tools for use in surgery centers, hospitals and other organizations by clicking here.

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3 Points on Conducting Patient Surveys