Provider Rating Survey
Asks about provider name, visit date, and listening and attentiveness. Built for multi-provider group practices benchmarking individual clinician performance.
- Questions
- 10
- Page
- 1
- Time
- about 3 min
Your practice
Provider Rating Survey
Live preview. Tap through it like a patient.
Who it is for
- Multi-provider group practices benchmarking individual clinician performance
- Medical directors building provider scorecards for quality improvement
- Healthcare organizations supporting professional development programs
- Credentialing committees gathering patient experience evidence
What's inside
- Provider NameText
- Visit DateDate
- Listening and AttentivenessMultiple Choice · 6 choices
- Explanation ClarityMultiple Choice · 5 choices
- Time Spent with PatientMultiple Choice · 6 choices
- Empathy and Bedside MannerMultiple Choice · 6 choices
- Shared Decision-MakingMultiple Choice · 6 choices
- Confidence in ProviderMultiple Choice · 4 choices
- Would Recommend ProviderMultiple Choice · 4 choices
- Additional FeedbackLong Text
From form to a ready patient

01
Make it yours
Reword, reorder, or add to the Provider Rating Survey, and add your logo.

02
Patients finish it at home
A secure link by text or email, filled out on their phone before the visit. No app.

03
Your team sees who is ready
Each visit shows as ready once its forms are in. Answers land on the patient record.
Related templates
All templatesQuestions
Send it before the visit, so patients arrive ready.
Add the Provider Rating Survey to your account and make it yours in a few minutes.
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