Free healthcare template
Hospital Feedback Form template
Capture patient experience across departments with accessible design. Ready to use: open it, change anything you like and share it in minutes.
Free forever plan · No card required · 8 questions · About 3 min to fill
What's in this template
These are the actual questions. Edit, remove or add your own in the builder.
- 1Department visited*Dropdown
- 2Type of visitSingle choice
- 3How would you rate your overall care?*Star rating
- 4Please rate the followingMatrix
- 5Please tell us what we could have done better.Paragraph
- 6How likely are you to recommend our hospital?Net Promoter Score
- 7Patient name (optional)Short answer
- 8Contact number (optional)Phone
How to make your hospital feedback form
Use this template free
Create a free account. The template opens in the builder, ready to edit. No card required.
Make it yours
Change questions, add your logo and colours, pick a theme and background, and set who gets notified.
Share and collect
Publish, then share the link, embed it on your site or print the QR code. Responses arrive with charts.
Questions about this template
Is this hospital feedback form template free?
Yes. Create a free Airform account, open the template and publish it. The Free plan needs no card, and your form stays live even if you reach the monthly response allowance.
Can I change the questions?
Every question, option and screen can be edited in the builder: add or remove questions, change the wording, reorder by dragging and apply your own theme and colours.
How do I share the hospital feedback form?
Publish it and share the link, embed it on your website, or download a QR code for posters, counters and printed material. On Professional, each link or QR code can be tracked as its own campaign.
Where do the responses go?
Every response appears in Airform with charts and filters, can be exported to CSV, and can be sent to OPM CRM as a lead with its source and consent.
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Start with the hospital feedback form template.
It takes a minute to make it yours. Free, with no card required.