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Patient Feedback Form Template

A patient feedback form helps you collect valuable opinions of your patients about the clinic, the hospital, their satisfaction rate, and so on. With patient feedback, you will know more about their experiences and what to change to satisfy your patients. And will provide you a great patient feedback form template to get started with!

Patient Feedback Form Template


Why use an online patient feedback form?

A patient satisfaction survey is a great way to evaluate how well you perform. And it also shows how you can improve the satisfaction rate of your patients. An online patient form will make the process simple and flexible for everyone. After you create a form by using’s free patient feedback form template, the patients can fill out the form anywhere, anytime. This way you will receive more feedback and have a greater chance to improve your clinic.

But there is more! Thanks to an online patient feedback form, you will be able to review the records and analyze results more easily and effortlessly. As well as showing the results in a user-friendly way, will create a special chart for each question on your survey form. This especially will allow you to see the broader picture and detect the exact weak and strong points in your clinic or hospital. Further, by using’s patient feedback form template, you can create your form in no time!  

How to create a great patient feedback form?

A service feedback form includes questions about several aspects of the hospital or medical care center. Patients or their relatives can rate their experience either by using the opinion scale or by writing the specific details. And while these questions or fields may vary for different clinics and hospitals, you can consider some points to make your patient feedback form great and professional.

  • Add a field for general opinion: After the specific questions, add a rating or text field to ask your patients about their general opinion. This may provide some valuable information on the overall satisfaction.
  • Have a simple layout: Keeping the questions and design simple will be a good choice for your evaluation form. Also, you can use’s professional-looking patient feedback form template directly or as a base for your form.
  • Make use of opinion scales and rating fields: Questions with a scale can be beneficial for both you and your patients. This way, they will be able to fill out the form more quickly and you will review the forms more easily.

How to edit your patient feedback form? provides highly customizable feedback form templates for your medical surveys. So, you can easily start editing the questions and fields to collect valuable feedback from your patients. Also, offers easy-to-use themes and handy features for customizing your form. That’s why you will create the perfect form with a few single clicks. Start collecting feedback by using’s patient feedback form template today!


Creating online forms and surveys is much easier than ever before. Without needing to code a single line, you can simply create forms or surveys and customize its fields, design, and general options with just a few clicks through’s intuitive form builder interface. After that, you can share using one or more of many sharing options and start collecting responses immediately. 

Powerful features: 

  • Conditional logic 
  • Create forms with ease
  • Calculator for exams and quote forms
  • Geolocation restriction
  • Real-time data
  • Detailed design customization

Forms and surveys that are created on can be easily integrated with many third-party applications via Zapier. You can integrate with more than 500 third-party applications such as Slack, MailChimp, and Pipedrive. For example, you can create contacts on MailChimp and send notifications to a specific Slack channel per submission you received through your forms.

It is alright if you don’t want to put in more time to create a form from scratch. Jumpstart with one of many ready-to-use templates and get to the work of collecting responses without bothering yourself at all. If you would like to, you can customize your template’s form fields, design and adjust general form settings.

You can share your forms in any way you like. If you want to share your form and collect responses through your form’s unique link, you can simply adjust privacy settings and copy-paste your form link anywhere. And if you would like to embed your form in your website, you can easily copy and paste embed code in your website HTML.

On, you can customize your form’s theme and design elements in depth. Once you switch to the ‘Design’ tab after getting your form done, you will see many different design customization options. You can change your form theme by choosing your own colors or picking one of many ready-made themes. 


Free Package Includes All Features

There are a lot of powerful and useful features on such as payment collection, product basket, and geolocation restriction. These features are all included in the free plan.


Get Familiar With Outstanding Features

Take a closer look at’s some of the most excellent features, see how they work and start using right away.