Today's Office Visit Survey Card

Trustees of Dartmouth College (Godfrey, Nelson, Batalden), Dartmouth, New Hampshire, USA
Institute for Healthcare Improvement, Cambridge, Massachusetts, USA


This four-question survey card is used to retrieve quick feedback to determine patient satisfaction for today's office visit. Use this survey card as a data collection method to determine patient satisfaction with the following:


Use the Today's Office Visit Survey Results Tally Tool to tally the results from the survey.

Download, print, and distribute to patients to complete the survey at checkout.

Choose one week each month to randomly ask 50 patients (e.g., flag every other appointment, or the first 50 appointments) to complete the survey at checkout and drop it in a box. Tally the results.


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