A physician satisfaction questionnaire is a document used to evaluate the performance of a general physician and also assess that the treatment her provides is effective or not. This questionnaire helps the physician to improve the quality and the procedure in which he provides treatment to the patient, as he will get to know whether there is anything lacking in his treatment. The questions in the questionnaire should be about the patients’ feedback on the treatment received.

Sample Physician Satisfaction Questionnaire

Patient name: ___________

Name of the Physician: _______________

Address: _______________

Date of birth: ___________

Residential Contact number: _______________ Mobile number: _____________

Email id: ______________

1. Are you satisfied with the treatment received?

a) Very satisfied

b) Satisfied

c) Somewhat satisfied

d) Dissatisfied

e) Vary dissatisfied

2. Was the physician able to communicate with you properly and understand your reason for illness?

a) Yes

b) Somewhat

c) No

3. Was he able to diagnose you with the right illness?

a) Yes

b) No

4. Do you agree that the treatment has helped you?

a) Yes

b) No

c) To Some extent

5. Do you feel that you have cured completely due to the treatment received?

a) Yes

b) Somewhat

c) No

6. How would rate the kind of consultation provided by the physician?

a) Excellent

b) Good

c) Average

d) Bad

e) Terrible

7. Would you like to visit this physician in future, if there is any health related issues?

a) Yes

b) Maybe

c) No

8. Would you like give any suggestion for improvement?