Patient Communication Audit Form
Use this Patient Communication Audit Form to document and evaluate communication practices during patient interactions. This form does not collect sensitive health or personal information.
Auditor Name
*
First Name
Last Name
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Department or Unit
*
Please Select
Reception
Nursing
Physician
Laboratory
Radiology
Pharmacy
Other
Type of Patient Interaction
*
In-person
Phone call
Video call
Email
Other
Communication Method Used
*
Verbal
Written
Digital (e.g., portal, messaging)
Non-verbal (gestures, body language)
Other
Was the information provided clear and easy to understand?
*
Yes
Somewhat
No
Professionalism and Courtesy Shown
*
1
2
3
4
5
Timeliness of Response
*
1
2
3
4
5
Opportunities for Improvement (please describe)
Overall Comments or Observations
Submit Audit
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