Clinic Evaluation Survey

Number of pages 4 Number of questions 14 Number of times used 2.2k+

Time to complete 4 minutes(approx.)

Gather immediate feedback on a patient’s experience at your clinic with a few key questions designed to provide actionable insight.
Survey Template

Every time patients visit a clinic, their experiences determine whether this visit will be their last, or one of many more. To keep up with patients’ needs and expectations, regular feedback collection can be a critical part of the processes and procedures in your medical clinic.

Clinic Evaluation Survey questions offer a simple way to measure and track basic aspects of the patient experience like reason for visit, wait time, clarity of communication, friendliness of staff, and quality of facilities. The survey asks for feedback on satisfaction with both the doctor/care provider and with the overall experience, as well as likelihood of returning and recommending the clinic to others.

Such data can make a huge difference in addressing patient needs in real time and in making plans for future improvements. Take care of your patients, but take care of your clinic, too. Diagnose any issues before they develop into a more serious condition, and you’ll be glad you did.




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