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Medical Survey Form

Medical Survey Form


A medical survey form is a form which is filled in by the patients or the persons who acquired medical services so as to know their satisfaction level. This type of form also helps to improve the medical services provided.

Medical Survey Template
Medical Survey Template
Medical Survey Template
Medical Survey Template

You can Download the Medical survey form Template, customize it according to your needs, and Print it. Medical survey form is either in MS Word or Editable PDF.

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Patient Information:

Name of the Patient (Optional)
Age of the Patient (Optional)
Contact Number (Optional)

Yes/No Rating Scales:

The template uses yes/no rating scales to ask patients about their satisfaction with various medical facilities or services provided

Open Ended Question:

An optional section for written comments or suggestions for improvement. This allows patients to elaborate on their experiences and also provide more specific feedback.


Patient Feedback:

The template provides a way to collect patient feedback on the medical facilities and also services provided. This feedback can be used to improve the quality of care provided to patients.

Identify Areas for Improvement:

By analyzing patient responses, medical facilities can identify areas where they can improve, such as patient satisfaction with staff attentiveness, cleanliness of the facilities, or wait times.

Improve Patient Communication:

The survey can open communication channels between patients and the medical facility, allowing patients to voice their concerns or suggestions.

Important Disclaimer: These templates are for informational purposes only. They are not a substitute for legal advice. Before using any template, consult with an attorney to ensure it meets your specific needs. EditableForms.com is not a law firm and cannot accept legal requests.