Satisfaction survey template
Clinic appointments and billing experience
A ready-to-use satisfaction survey template with 11 questions already written and tested. Open it, brand it as your own and launch in minutes. Free to start, no card required.
Satisfaction surveys measure how the people who already bought or used you actually feel: where you exceed expectations and where you lose customers. Send it right after the experience, while the memory is fresh, and pair the score with an open comment to learn not just how much, but why.
What respondents see
We want to improve the administrative side of your visit: booking, reminders, paperwork, insurance and billing. We never ask about your treatment or any health data. About 3-4 minutes.
What this template asks
- Yes / NoIn the last six months, have you arranged an appointment or a payment with the clinic, for yourself or for a family member?
- Yes
- No
- Single choiceHow did you book your most recent appointment?
- By phone
- Through the clinic's website or app
- By WhatsApp or a messaging app
- By email
- In person, at the front desk
- Through my insurer or health plan
- Someone else booked it for me
- I don't remember
- ScaleIt was easy to get an appointment on the date and time I needed.
Strongly disagree 1–5 Strongly agree
- Single choiceDid you receive a reminder before the appointment?
- Yes, far enough in advance
- Yes, but too late for me to organise myself
- Yes, but with something wrong in it (date, time or professional)
- I did not receive any reminder
- I don't remember
- Yes / NoHave you ever needed to reschedule or cancel an appointment at the clinic?
- Yes
- No
- ScaleRescheduling or cancelling that appointment was easy.
Strongly disagree 1–5 Strongly agree
- MatrixHow would you rate these administrative aspects?
- The paperwork and documents I had to provide
- Dealing with my insurer or health plan
- The waiting time at reception or the front desk
- How the administrative staff treated me
- How clear the invoice or payment receipt was
- Very poor
- Poor
- Acceptable
- Good
- Very good
- Not applicable
- Yes / NoBefore the visit, were you told how much you would pay?
- Yes
- No
- Yes / NoDid the final amount match what you had been told?
- Yes
- No
- Single choiceHow did the final amount differ?
- It was higher and nobody warned me beforehand
- It included items I was not expecting
- My insurer or health plan covered less than expected
- What I was quoted was only an estimate and it was not clear
- It was lower than I had been told
- Another reason
- I'd rather not say
- Open textWhat would you change about appointment handling, paperwork or billing? Please do not include any health information.
Frequently asked questions
- What is a satisfaction survey template?
- It is a pre-built satisfaction survey questionnaire with 11 ready-to-send questions. Use it as-is or adapt it to your case in Camaleonic Survey's visual editor.
- Is it free?
- Yes. You can create an account and use this template for free, no card required. Paid plans add advanced analytics, live results and more.
- Can I customize it?
- Completely. Change questions, logic, typography and color so the survey looks like your brand, not a generic form.