Patient Feedback Forms

12 Templates

Patient feedback is important to ensure you’re taking good care of your patients. Whether you work at a doctor’s office, dentist’s office, or other healthcare provider, JotForm’s free Patient Feedback Forms can help you collect feedback seamlessly from any device — great for telemedicine or in-person services! Start by selecting a free template below and customizing it with our drag-and-drop builder. Then embed the form in your website or share it to patients with a link, and view responses in your secure JotForm account.



Feel free to make changes to your chosen Patient Feedback Form template. Drag and drop to add or update questions, upload your logo, or change the form design. All responses are protected with a 256-bit SSL connection and a HIPAA compliance option for healthcare professionals. Once you’ve gathered feedback, you can view it as a spreadsheet or cards in JotForm Tables — or even generate reports in JotForm Report Builder! Switch from paper forms to online forms to collect data fast with free online Patient Feedback Surveys.

Patient Feedback Form

Get patient feedback with this online feedback form and improve your service.

Healthcare Forms
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Dental Customer Feedback Form

Form A Dental Customer Feedback Form is used by dentists to gather customer feedback regarding their experience. With a Dental Customer Feedback Form, you can collect customer feedback for your dental practice! Just customize the form fields to match your dental practice’s needs and use the free JotForm Mobile Forms app to collect responses even when you’re not in the office.

Patient Feedback Forms
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Energy Medicine Treatment Feedback Form

This form aims to collect feedback from customers about Healy Resonance treatments.

Healthcare Forms
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Student Healthcare Leaders (SHL) Feedback Form

Feedback form for students after completion of program

Education Forms
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Mental Health Awareness Feedback Form

A mental health awareness feedback form is used by medical professionals and practitioners to gather feedback from patients about their mental health. It may be used by psychiatrists, psychologists, counselors, social workers, and a variety of other medical professionals.

Feedback Forms
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Session Assignment and Feedback Form (SAFF)

Therapy session assignment and feedback form

Healthcare Forms
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IYJ Program Feedback Form- Participant

Feedback from about program participation and structure from participant perspective

Feedback Forms
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Life Quality + UK diabetes diet Questionnaire

Life Quality Questionnaire The UK diabetes diet Questionnaire

Patient Feedback Forms
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