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
2. How do you rate the quality of our business practices in terms of meeting your perceived needs?
Extremely satisfied
Somewhat satisfied
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?
Somewhat Affordable
Somewhat 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
6. How would you rate the performance of our customer service representative?
Very Good
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

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