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Health Insurance Patient Satisfaction Survey Template

Survey on the quality of a patient's current healthcare provider.



   
 
 


Please take a few minutes to fill out this survey on how you feel about our agent’s services. We value your feedback and your responses will be kept confidential. Thank you for your input.
 
   
 
1. How quickly were your concerns attended to?
 
Very quickly
 
Moderately quickly
 
Slightly quickly
 
Not at all quickly
 
N/A
 
   
 
2. How do you rate the quality of our business practices in terms of meeting your perceived needs?
 
Extremely satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Extremely dissatisfied
 
   
 
3. Overall how do you feel about accessibility of the customer service representative?
 
Highly accessible
 
Moderately accessible
 
Somehow accessible
 
Not at all accessible
 
   
 
4. Overall how would you rate the cost of our services?
 
Affordable
 
Somewhat Affordable
 
Neutral
 
Somewhat Unaffordable
 
Unaffordable
 
   
 
5. How familiar are you with new policies and trends in the insurance industry?
 
Highly familiar
 
Moderately familiar
 
Slightly familiar
 
Not at all familiar
 
N/A
 
   
 
6. How would you rate the performance of our customer service representative?
 
Very Good
 
Good
 
Average
 
Poor
 
Very Poor
 
   
 
7. Have you at any time doubted our credibility in meeting your demands or adjustments?
 
Never doubted
 
Slightly doubted
 
Somewhat doubted
 
Moderately doubted
 
Highly doubted
 
   
 
8. How likely is it that you would recommend your health insurance to other agents?
 
Extremely likely
 
Very likely
 
Moderately likely
 
Slightly likely
 
Not at all likely
 
N/A
 
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