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Satisfaction survey template

Clinic facilities: cleanliness, comfort and accessibility

A ready-to-use satisfaction survey template with 10 questions already written and tested. Open it, brand it as your own and launch in minutes. Free to start, no card required.

10 questions · ~2 min

Use this templateSee the product

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

Tell us how you found our premises: cleanliness, waiting area, signage, accessibility and toilets. It takes 3 to 5 minutes and asks only about the physical space, not about clinical care.

What this template asks

  1. Yes / NoHave you visited our premises in person in the last 3 months?
    • Yes
    • No
  2. Single choiceRoughly how long did you spend inside the clinic on that visit?
    • Less than 15 minutes
    • Between 15 and 30 minutes
    • Between 30 and 60 minutes
    • More than 60 minutes
    • I don't remember
  3. MatrixPlease rate the following aspects of the premises during that visit.
    • Overall cleanliness
    • Comfort of the waiting area (seating and space)
    • Temperature and ventilation
    • Noise level
    • Lighting
    • Signage for finding your way around
    • Privacy when speaking at the reception desk
    • Very poor
    • Poor
    • Acceptable
    • Good
    • Very good
    • Not applicable / I don't remember
  4. Yes / NoDid you use the clinic's toilets during your visit?
    • Yes
    • No
  5. ScaleHow do you rate the condition of the toilets (cleanliness, paper, soap, smell)?

    Very poor 1–5 Very good

  6. Yes / NoDid you or the person with you get around using a wheelchair, crutches, a pushchair or with any mobility difficulty?
    • Yes
    • No
  7. ScaleHow easy was it to move around the clinic in that situation (entrance, lift, corridors, accessible toilet)?

    Very difficult 1–5 Very easy

  8. Multiple choiceWas there anything about the physical space that made you uncomfortable? You can choose up to 3 options.
    • The noise
    • The temperature
    • The smells
    • Not enough seats
    • Little privacy at reception
    • Difficulty finding my way
    • Cleanliness fell short
    • The toilets
    • Nothing made me uncomfortable
  9. ScaleOverall, how satisfied are you with the clinic's facilities?

    Not at all satisfied 1–5 Very satisfied

  10. Open textIf you could change one single thing about the facilities, what would it be?

Frequently asked questions

What is a satisfaction survey template?
It is a pre-built satisfaction survey questionnaire with 10 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.

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