Outpatient Clinic Feedback Form

About this template

This Outpatient Clinic Feedback Form is designed to gather valuable feedback from patients about their experience at the outpatient clinic. By using this form, healthcare providers can gain insights into the satisfaction levels and identify areas for improvement in their clinic services.

Form Questions:

1. Overall Satisfaction Rating: The first question asks patients to rate their overall satisfaction with their visit to the clinic. This rating helps assess the overall patient experience.

2. Reason for Visit: Patients are prompted to select the reason for their visit, such as a medical consultation, diagnostic tests, follow-up appointment, or other. This information provides context for understanding different aspects of patient experiences based on their purpose of visit.

3. Cleanliness Rating: This question uses a Likert scale to assess the cleanliness of the clinic. It enables patients to rate the cleanliness level and helps identify areas that may require improvement. This question is conditional based on the overall satisfaction rating. If the satisfaction rating is less than 4, patients are asked to rate the cleanliness.

4. Staff Instructions: Patients are asked to indicate whether the clinic staff provided clear instructions regarding their treatment or procedure. This helps evaluate the effectiveness of communication and guidance provided by the staff.

5. Additional Comments: Patients are given an opportunity to provide any additional comments or suggestions for improving outpatient clinic services. This question allows patients to share specific feedback or suggestions that may not have been covered in the previous questions.

This Outpatient Clinic Feedback Form can be a valuable tool for healthcare providers to enhance patient satisfaction and improve overall clinic services. Gathering feedback and actively addressing patient concerns can contribute to a better patient experience and quality of care.