Prefer it online? Patients fill it out on their phone before the visit.
Practice name: ______________________________
New Patient Onboarding Feedback Survey
Your information
Visit Date
____ / ____ / ________
How Did You Find Us
- Web search
- Friend or family
- Another healthcare professional
- Insurance directory
- Social media
- Other
Scheduling Ease
- Very easy
- Easy
- Neither easy nor difficult
- Difficult
- Very difficult
- Not applicable
Pre-Visit Instructions Clarity
- Very clear
- Mostly clear
- Somewhat unclear
- Not clear
- Not applicable
Registration / Paperwork Experience
- Excellent
- Good
- Fair
- Poor
- Very poor
- Not applicable
Front Desk Staff Helpfulness
- Excellent
- Good
- Fair
- Poor
- Very poor
- Not applicable
Additional details
Wait Time Satisfaction
- Very satisfied
- Satisfied
- Neither satisfied nor dissatisfied
- Dissatisfied
- Very dissatisfied
- Not applicable
Provider Communication Quality
- Excellent
- Good
- Fair
- Poor
- Very poor
- Not applicable
Confidence in Care Plan
- Very confident
- Somewhat confident
- Not confident
- Need more information
Overall First Impression
- Excellent
- Good
- Fair
- Poor
- Very poor
- Not applicable
What Could We Improve
Would Recommend to Others
- Yes
- No
- Not sure
- Not applicable
New Patient Onboarding Feedback Survey template from formisoft.com. formisoft.com/intake-templates/new-patient-onboarding-feedback