A Patient Feedback Form is designed to collect structured feedback about patient experiences in a clear and organized way. This template helps healthcare providers gather insights on service quality, communication, and overall satisfaction while keeping the process simple for patients.

Using Fluent Forms, you can collect basic demographic details such as date of birth and gender through date and dropdown fields. A checkable grid allows patients to share their opinions across multiple aspects of care, while a text area gives them space to suggest improvements or share additional comments. All responses are stored in one place, making it easy to review feedback and identify areas that need attention.

This Patient Feedback Form can be customized to fit clinics, hospitals, or private practices, and works smoothly on any device, ensuring patients can submit feedback comfortably and confidently.