OPD patient feedback form: a free template and the questions that matter

Most OPD feedback forms end up in a box nobody opens, or in a file kept for the assessor. The form below is built to be used: twelve questions a patient can answer in two minutes, in English and Hindi, and a way to read the answers and act on them every month. Copy it freely.

Which questions belong on an OPD feedback form?

Ask about each step of the visit, in the order the patient met it, because each step has someone who can fix it. Indian studies point to the same few steps. At a tertiary hospital in Maharashtra, exit interviews found patients’ dissatisfaction centred on waiting at the registration desk and outside the OPD, seating, cleanliness and the availability of medicines, and patients who waited less were significantly more satisfied. At a teaching hospital in Jharkhand, 58.3% of 400 patients waited more than three hours in all, and longer waits went with lower satisfaction and less willingness to come back.

The government’s own OPD format for public hospitals, in its 2021 quality guidelines, rates ten attributes from Poor (1) to Excellent (5), from signage to medicines and overall satisfaction, and ends with four open questions. The template below keeps a five-point scale and adds three things that format leaves out: being told about delays, privacy during the examination, and charges explained before paying. The last two are patient rights in NABH’s standards (PRE.2.b and PRE.6).

Four rules for the wording:

• One thing per question. “Was the doctor polite and quick?” asks two things.
• Everyday words: “waiting area” rather than “amenities”, “charges” rather than “billing transparency”.
• A “Not used” box for steps not everyone goes through, so a patient who never visited the lab doesn’t pull its score down.
• Ask how long they waited. Question 11 lets you compare what patients felt with what your register recorded.

The form: copy it, print it, add your hospital’s name

Print it on one side of a page in large type, and draw simple faces above the five numbers for patients who read little. If many of your patients speak another language, add it as a third column.

When and how to collect it

The government’s guidelines for public hospitals set out a method that works in any OPD (Annexure J of the 2021 quality guidelines):

• At the exit. They prefer feedback taken as patients leave, at the pharmacy counter for OPD patients; in a private OPD, wherever the visit ends.
• In the patient’s language. Translate the form into the local language and keep copies at registration, the help desk and the OPD clinics.
• From everyone. Take feedback by voice from patients who can’t read, and from parents for children. Write down what they say, not what you think they mean, and tick “staff member reading it out”.
• Across the whole OPD. Cover every department, especially the busiest clinics.
• Often enough. Monthly in large hospitals such as district hospitals, quarterly in small ones such as primary and community health centres. The NQAS OPD checklist for district hospitals asks for an OPD patient satisfaction survey every month.
• Enough forms. Never fewer than 30. The guidelines’ sample-size table, based on the previous quarter’s OPD attendance, asks for 88 to 96 forms for an OPD seeing 1,000 or more patients, for a 10% margin of error at 95% confidence.

Two habits of our own: someone other than the treating doctor hands out the form, with a box to drop it in, and nobody compares doctors until each has 30 forms. A QR code at the exit can open the same questions online; keep the name and number optional there too.

Can you ask for feedback on WhatsApp or SMS?

Yes, but only from patients who said yes to it.

• Opt-in first. WhatsApp’s Business Messaging Policy lets a business contact people only if they have given it their number and opted in to its messages, and suggests separate opt-ins for different kinds of message. A yes to appointment reminders may not cover feedback requests, so ask about both.
• Consent you can prove. The DPDP Act’s consent rules come into force on 13 May 2027. Consent must then be free, specific, informed, unconditional and unambiguous, shown by a clear affirmative action, for a stated purpose (section 6(1)); withdrawing it must be about as easy as giving it (6(4)); and the hospital must be able to prove the notice and the consent (6(10)). Log who said yes, when, on which channel and for what. Our guide to the DPDP Act for hospitals covers notices and consent in full.
• One visit, nothing to sell. Meta’s template rules accept a feedback request as a utility message only when it is specific to the visit it asks about: a generic survey won’t be approved as utility, and a survey with promotional content counts as marketing. More in our WhatsApp guide for hospitals.
• The next day. For public hospitals linked to it, the government’s Mera Aspataal system sends patients an SMS the day after the visit asking whether they were very satisfied, satisfied or not satisfied, and those not satisfied get a call asking why.

A message can be this short (a template; the date is an example):

How to read the results

Each month, for each rated question:

1. Average the scores from 1 to 5, leaving out “Not used”. The government’s worked example also averages each question, then works out an overall score.
2. Count the share of 4s and 5s, because an average of 3 can mean everyone was lukewarm or half were angry.
3. Take the two lowest questions. The 2021 guidelines ask for a root-cause analysis of the two lowest-scoring attributes.
4. Sort the comments into a few heaps (waiting, staff, doctor, cleanliness, charges, other) and count them. Scores show how much; comments show why.
5. Compare question 11 with your waiting-time register. If patients report much longer waits than the register, it is probably missing time, often before patients reach the OPD. Our guide to measuring OPD waiting time the NABH way shows how to keep one.
6. Look for changes that last two or three months. With around 90 forms a month, small moves in an average are often chance.

An illustration, with made-up numbers from 92 forms in one month:

The two lowest are waiting (2.9) and being told about it (3.0), and in this example most comments are about waiting too. The register then shows why: the Monday orthopaedic session starts about 40 minutes late, and booked patients are still told to come at 9.

What NABH and NQAS expect

The NABH 6th-edition standards put patient feedback under standard PRE.7, in the chapter on Patient Rights and Education: the hospital has a mechanism to capture patients’ feedback and experience, and to redress complaints. Its six objective elements, in short:

The chapter’s intent mentions patient-reported experience measures (PREMs), and PRE.2.h makes the right to complain, and to know how, a patient right. The standard’s text doesn’t prescribe a form, a scale or a frequency: you define them in your own procedure, and you are assessed on following it.

For public hospitals, standard G2 of the National Quality Assurance Standards 2024 asks for patient satisfaction surveys at periodic intervals (G2.1), analysis of the feedback with root-cause analysis (G2.2), and action plans for the areas of low satisfaction (G2.3). The District Hospital OPD checklist adds a monthly OPD survey and a documented procedure for running and analysing it, and the 2021 guidelines make the patient satisfaction score one of the critical criteria for NQAS certification.

How to close the loop

1. Call back every unhappy patient who left a number: anyone who gave a 1 or 2, within a time you set and write into your procedure, such as two working days. PRE.7.e asks for a defined time frame.
2. Treat serious comments as complaints. Rudeness, a billing dispute or anything suggesting harm goes into your complaint procedure, which is a core element (PRE.7.c).
3. Fix the two lowest scores. Each month the quality team finds their root causes and writes an action plan: what, who and by when. The 2021 guidelines ask for compliance with the plan to be reviewed monthly.
4. Tell staff what patients said, praise as well as problems. NABH’s PSQ.3.h asks that feedback about care and service reaches staff.
5. Tell patients what changed. A “You said, we did” board in the waiting area, in Hindi and English, shows that the forms are read: “You said nobody told you when the doctor was late. Now reception announces every delay.”
6. Measure again next month, and keep the two scores on a simple run chart.

Where DrMate fits

Keep your feedback form, on paper or by message, for every patient. For waiting, which the two Indian studies cited above tie to lower satisfaction, DrMate’s front desk gives each booked patient a time or an arrival window and an expected wait, and tells those who said yes to WhatsApp updates when the doctor is running late.