Patient Satisfaction Survey

Most practices find out a patient was unhappy when the patient stops booking. The complaint never reaches the front desk; it goes to a review site, or nowhere at all, and the schedule quietly thins out. This survey exists to catch that feedback while there is still time to act on it.

The Patient Satisfaction Survey template asks for 4 to 6 minutes of a patient's time and returns scores on the things that decide whether they come back: care quality, staff friendliness, and how the visit felt overall. It runs on Uplup's free plan, and every part of it can be edited before you send anything.

Eleven questions, from name to net promoter

The form holds 11 fields spread across a cover page, content pages, and an ending page. It opens with identity basics: full name and email are required, while phone and date of birth are optional. That balance lets you connect feedback to a patient record without demanding more than people want to give after an appointment.

The core is four required rating questions on a 5-point scale: Overall Experience, Wait Time, Staff Friendliness, and Quality of Care. After the ratings comes a blunt multiple choice question, Would you recommend us?, with answers running from Definitely down to Probably not, an optional Comments box for anything the scores missed, and a standard NPS question asking how likely the patient is to recommend you to a friend or colleague. The NPS number gives you something to track quarter over quarter; the comments explain why it moved.

Made for the person who manages the waiting room

Practice managers at medical and dental clinics are the obvious senders, but the structure fits any care setting that depends on repeat visits: physical therapy studios, urgent care centers, optometrists, veterinary practices. If retention pays your bills, these questions apply. Nobody on staff needs survey design experience; the template ships complete, and every field can be reworded or swapped in the editor.

Uplup recommends running this one in conversational mode, which shows one question at a time. A patient answering on a phone in the parking lot gets a quick back and forth instead of a wall of fields. If you'd rather add a progress bar or let patients step back to a previous answer, both are settings you can switch on before sharing.

Reading the scores before they turn into cancellations

Responses land in Uplup's analytics with per-question breakdowns. If Wait Time averages 2.8 while Quality of Care holds at 4.6, you have a scheduling problem, not a clinical one, and you learned it without guessing. The recommendation question shows how many patients sit at Not sure, which is where quiet churn hides.

Export everything to CSV for a monthly ops review, or push submissions into your other systems through webhooks and Zapier. Because a name and email ride along with every response, a bad score is not an abstract data point. It is a specific patient your front desk can call this week, before the next appointment gets skipped.

Reaching patients while the visit is still fresh

Feedback quality drops fast after checkout, so the survey is built to travel. Text or email the link the same day, print the QR code for the front desk, or post it to your social accounts. You can embed the survey on your website with a snippet, and WordPress sites can place it using the Uplup plugin's shortcode.

Add your practice's logo and colors so the survey looks like yours rather than generic software. At 4 to 6 minutes, it respects patients' time, and that alone does more for completion rates than any reminder email.