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Example patient feedback form

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Example, patient feedback questions

Patient Satisfaction Questionnaire for Patients Know Best (PKB)

Thank you for being a registered user of Patients Know Best (PKB). Your feedback is invaluable to us as we strive to continually improve our services. Please take a moment to complete this questionnaire to help us understand your satisfaction levels and preferences regarding PKB.

Demographic Information:

  1. Age (single select):

  • Under 18

  • 18-25

  • 26-35

  • 36-45

  • 46-55

  • 56-65

  • 65+

  1. Gender (single select):

  • Man

  • Woman

  • Other

  • Prefer not to say

  1. Ethnicity (single select):

  • White - British

  • White - Irish

  • White - Any other White background

  • Mixed - White and Black Caribbean

  • Mixed - White and Black African

  • Mixed - White and Asian

  • Mixed - Any other mixed background

  • Asian or Asian British - Indian

  • Asian or Asian British - Pakistani

  • Asian or Asian British - Bangladeshi

  • Asian or Asian British - Any other Asian background

  • Black or Black British - Caribbean

  • Black or Black British - African

  • Black or Black British - Any other Black background

  • Other Ethnic Groups - Chinese

  • Other Ethnic Groups - Any other ethnic group

  • Not stated

  • Not known

(3b) Is English your first language?

Yes 

No 

  1. How would you rate your IT proficiency (single select)?

  • Beginner

  • Intermediate

  • Advanced

  1. How helpful is it to access your health information on PKB?

    • Very helpful

    • Somewhat helpful

    • Neither helpful nor unhelpful

    • Somewhat unhelpful

    • Very unhelpful

  2. Overall, how satisfied are you with your experience using PKB?

    • Very satisfied

    • Somewhat satisfied

    • Neither satisfied nor dissatisfied

    • Somewhat dissatisfied

    • Very dissatisfied

  3. How likely are you to recommend PKB to a friend or family member (single select)?

  • Very likely

  • Likely

  • Neutral

  • Unlikely

  • Very unlikely

  1. Which features do you use on PKB (multi select):

  • Blood tests

  • Radiology reports

  • Outpatient appointments

  • Radiology appointments

  • Letters

  • Adding my own data

  • Measurements

  • Other

  1. How did you hear about PKB (Single select):

  • Letter from hospital

  • Word of mouth

  • Hospital Poster

  • Digital TV Screen within the Hospital

  • From my GP

  • From my Consultant

  • Text message

  • Hospital kiosks

  • Local newspapers

  • Other

  1. How often do you use PKB (single select):

  • Daily

  • Weekly

  • Monthly

  • Seasonal

  • Yearly

  • Never

  1. Which of the following do you think would be most useful in PKB (multi select):

  • Messaging my clinical team

  • Link to my video appointment

  • Library with all relevant information

  • Individual or condition care plans

  • Digital questionnaires throughout my treatment 

  • Ability to reschedule/ cancel my appointment.

  • Other

Further information