Physician Feedback Form

Gather feedback from physicians to improve the quality of service.

30-day risk-free trial. No credit card required.

About this template

The Physician Feedback Form is designed to collect valuable feedback from physicians to enhance the quality of healthcare services provided. This form aims to understand the overall satisfaction of physicians, identify areas of improvement, and gather suggestions for enhancing healthcare services.


  1. Overall satisfaction rating: The form begins by requesting physicians to rate their overall satisfaction with the healthcare services. This helps assess the general impression and satisfaction level.

  2. Likelihood to recommend: Physicians are asked to indicate their likelihood of recommending the healthcare services to others using the Net Promoter Score (NPS) scale. This provides insights into their loyalty and advocacy for the services.

  3. Primary strength: Physicians are encouraged to share the primary strengths of the healthcare services. This helps identify areas where the services excel and can be leveraged further.

  4. Suggestions for improvement: This open-ended question allows physicians to provide specific suggestions for improving the healthcare services. Their feedback and insights can contribute to enhancing the overall quality of care.

  5. Communication effectiveness: Physicians are requested to rate the effectiveness of communication. The likert scale question helps understand their perception of communication practices and identify potential areas for improvement.

  6. Interest in receiving updates: Physicians are asked if they would like to receive updates on new medical advancements and research. This provides an opportunity to engage them further and keep them informed.

  7. Email address (optional): If physicians express interest in receiving updates, they have the option to provide their email address.

This Physician Feedback Form helps healthcare organizations gather actionable feedback to improve customer experience and enhance the quality of care provided to physicians. By leveraging the insights gained from this form, organizations can make informed decisions and implement changes that align with physicians’ needs and expectations.

Give your business a boost with TRACX®

Sign up for free and get everything you need to turn visitors into customers, and customers into super-fans — all in one platform.

  • TRACX is free forever
  • Upgrade anytime, cancel anytime
  • No coding necessary
  • Get set up in seconds
  • GDPR & CCPA-ready
  • Hosted in EU datacentres