Patient Feedback Form Template

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Feedback makes everyone better

If you’re looking for an easy way to ask your patients for feedback, you’ve found it. This patient feedback form is easy to fill out and will give you honest, focused answers—because it only asks one question at a time.

Patient feedback form FAQs:

1. How can I help my patients give meaningful and constructive feedback?

We’ve all been presented with feedback surveys that were the opposite of inviting. With vague or convoluted questions and the robotic feel of more traditional forms, it can be easy for feedback to feel like no more than a box-ticking exercise. Time for a change.

This patient feedback form asks one question at a time and lets you follow up on ratings with deeper questions. Your patients will feel that their feedback is truly being heard, and you’ll learn a lot in the process.

2. What’s the benefit of asking only one question at a time?

It helps your patients focus on one aspect and give in-depth answers about that topic. This will help you gather less generic, and more actionable data for points of improvement.

Moreover, this format has a more human feel to it than a list or page. It feels like a real conversation, which is a great way to personalize the after care process for your patients.

3. What should I consider before using this healthcare form?

Before you send out your form, there are two things you should do:

  1. Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. Do this by filling out this typeform, or contacting your Typeform account manager.

  1. Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.

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Here's what people say about us

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro
Collect 18% more data with Typeform compared with our two main competitors in the market

How does it work?

Make a stylish form in minutes with our drag-and-drop builder.

Choose from different question types: multiple choice, rating, opinion scale, free-form text, and more.

Take respondents down different paths based on their answers.

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