Patient Satisfaction Survey Template

After a series of treatments ends, a patient mentions in the corridor that it was hard to get through to the practice by phone. Someone else admits they did not know how long the series would last. This is valuable information, but it is lost if nobody writes it down. A short survey lets you collect it regularly, not by chance.

Below you will find a patient satisfaction survey template for a small physiotherapy practice and an answer to the question asked most often: does the Act require you to run one. The answer depends on whether you have a contract with the National Health Fund (NFZ). Neighbouring topics, namely complaints and adverse events, are covered in separate articles that we link to.

Key points

• The Act on quality in health care requires a survey of patients' opinions and experiences from an entity that provides medical services under a contract with the NFZ (Article 18(1) and (3)(7)). If you see patients only privately, you do not apply this provision directly.
• The Ministry of Health publishes survey templates. On the ministry's website there is no template marked as rehabilitation or physiotherapy, and the templates are described there as recommended.
• A good survey has 5-8 questions. Answers on a scale plus one open question are enough.
• Do not ask about health details and do not collect unnecessary data. A patient's answer in a named survey may be data concerning health.
• Review the results regularly and record what you decide to change. A survey without conclusions gives little.

Why run a survey in a small practice

Three practical reasons, regardless of any duty:

1. You see problems earlier. Unclear cancellation rules, a cold room, a long wait in the waiting area. A patient rarely reports these directly, but will write them in an anonymous survey.
2. Complaints surprise you less often. Some dissatisfaction comes out in the survey before it turns into an official complaint. Handling complaints is covered in the article on complaints about physiotherapy services.
3. You have evidence that you monitor quality. If you work under an NFZ contract, such a record is part of the required system. If not, it shows that you run the practice deliberately.

Does the Act require a satisfaction survey

Source: the Act of 16 June 2023 on quality in health care and patient safety.

Who is bound. Article 18(1): an entity providing medical services under a contract for the provision of publicly funded health care services concluded with the Fund (the NFZ) must have an internal system (rules, procedures, methods and job descriptions) intended to prevent adverse events. Article 61 set the deadline for creating such a system at 30 June 2024.

Where the survey sits. Article 18(3)(7) lists, among the elements of the internal system, surveys of patients' opinions and experiences based on the survey referred to in Article 20(1). The system is also run on the basis of an assessment of its effectiveness and the results of these surveys (Article 18(2)).

How it looks in practice. Article 20(1) says the survey is carried out with a questionnaire whose template the Minister of Health publishes in the Public Information Bulletin (BIP). For entities other than inpatient ones (so also for a practice), Article 20(3) requires only that the entity inform patients, in a way of its choosing, of the possibility of filling in the survey, in a manner that ensures freedom to express an opinion.

What follows for you:

Your situation	What follows from Articles 18 and 20
A practice with an NFZ contract	You have an internal system, and in it a survey of patients' opinions and experiences. You inform patients of the possibility to fill in the survey
A purely private practice	Article 18(1) ties the duty to an NFZ contract. The survey is voluntary

The Ministry of Health publishes survey templates on its page with patient experience and opinion surveys. According to that page (checked on 2 November 2026) you will find templates there for a hospital, primary care, a home visit, a teleconsultation, outpatient specialist care and long-term care. Among them there is no template marked as rehabilitation or physiotherapy, and the page describes them as recommended for use. If you have an NFZ contract, ask your NFZ branch which template it considers appropriate for your scope. We do not decide that here.

The quality Act is not the only thread of this topic. The internal quality system is covered in more detail in the article on the healthcare quality Act and the internal system at a practice. In this article we stay with the literal wording of Article 18(1).

Which questions to ask

The template below is our proposal for a small practice. It is not a ministry template. Scale: from 1 (definitely not) to 5 (definitely yes).

Patient satisfaction survey - template

1. It was easy to book a visit (phone, internet, message). 1 2 3 4 5
2. The visit started at the agreed time, or I was told about a delay. 1 2 3 4 5
3. The therapist explained what they were doing and why. 1 2 3 4 5
4. I felt I could ask questions. 1 2 3 4 5
5. The practice was clean and comfortable (temperature, privacy, waiting area). 1 2 3 4 5
6. I would recommend this practice to a friend. 1 2 3 4 5
7. What could we improve? (open field, a few sentences)

Add one sentence at the top: "The survey is anonymous and voluntary. Please do not write personal data or details of your health."

Rules for building it:

• One question, one matter. Do not combine cleanliness and waiting time in one sentence.
• The same scale in every question. It is easier to compare results from successive quarters.
• An open field without leading. The question "what could we improve" gives more than "was everything good".
• No questions about health. Do not ask about the diagnosis or the effect of treatment in medical terms.

Paper, QR code or email: GDPR

Personal data is information about an identifiable person. The GDPR also defines "data concerning health" as data about a person's health, including the use of health care services, which reveals information about their state of health (Article 4(1) and (15)). A patient's name alone in an answer to a survey from a practice may therefore be such data. For this reason the simplest approach is to make the survey anonymous.

Format	Advantages	What to watch
A sheet of paper and a box in the waiting area	The patient leaves no trace online. The simplest GDPR position	Do not ask for a name, and do not add the visit date or therapist to the sheet if that makes the person identifiable
A QR code to an online form	Fast, convenient for the patient, results add up automatically	Choose a tool that does not collect an email address or other data. If a provider processes data on your behalf, check whether a data processing agreement is needed (Article 28 GDPR)
An email or SMS with a link	Reaches patients after the series	A message is always contact with a specific person. Do not combine it with an offer or a request for marketing consent. Rules for contact are covered in the article on SMS and email to patients

Rules that apply regardless of format:

• Minimisation. Data must be adequate and limited to what is necessary for the purpose (Article 5(1)(c) GDPR). You do not need a surname to measure satisfaction.
• Storage limitation. You keep data in a form that permits identification for no longer than necessary (Article 5(1)(e)). If the survey is truly anonymous, this problem disappears.
• Information for the patient. If you collect personal data (for example in a named survey), you must give the information listed in Article 13(1) GDPR: who the controller is, for what purpose it processes the data and on what basis.

We did not check the provisions on electronic communication that may apply to messages sent to patients.

What to do with the results

A survey nobody reads is a waste of the patient's time. A simple scheme for a small practice:

1. Once a quarter review the collected sheets or answers. Calculate averages for questions 1-6 and read all answers to question 7.
2. Write the conclusions in one paragraph: what repeats, what is good, what you are improving.
3. Assign an action: who, what and by when. For example: "we change the text of the SMS visit reminder so that it clearly gives the cancellation number".
4. Check after the next quarter whether the change helped.

Two exceptions to the scheme:

• If someone in a survey describes a situation in which the patient may have suffered a harmful effect of treatment, treat it as a signal to enter an event in the register. How to do that is described in the article on the register of adverse events.
• If someone writes directly that they are making a complaint, it does not end with the survey. Treat it as a complaint and respond according to the practice's procedure.

You can also use the survey results in communication about the practice, but with caution. Rules on publishing opinions in promotional materials are discussed in the article on practice marketing and the law.

Frequently asked questions

Must a physiotherapy practice run a patient satisfaction survey?

Under the quality Act, the duty to survey patients' opinions and experiences is part of the internal system that applies to an entity providing medical services under an NFZ contract (Article 18(1) and (3)(7)). A purely private practice has no such duty under that provision. It is still worth running a survey voluntarily.

Do I have to use the Ministry of Health survey?

Article 20(1) provides for a survey template published by the Minister in the BIP. The ministry publishes templates on its website and describes them as recommended, but we did not find one there for rehabilitation. If you have an NFZ contract, ask the NFZ branch which template to use.

Can the survey be named?

It can, but then you collect personal data, and the patient's data may be data concerning health (Article 4(1) and (15) GDPR). You must meet the information duty under Article 13 and make sure the data is limited to what is necessary. An anonymous survey is simpler.

How often should I run the survey?

The Act does not say. A practical approach is a fixed set of questions for all patients after a series of treatments ends, and a review of results once a quarter.

Can I send the survey by SMS or email?

You can, but it is contact with a specific patient. Do not attach an advertisement or a request for marketing consent. Rules for sending messages are covered in the article on SMS and email to patients. We did not check the provisions on electronic communication, so we do not decide which conditions they impose.

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Legal status as of: 2 November 2026

Legal basis: Act of 16 June 2023 on quality in health care and patient safety (Journal of Laws 2023 item 1692, amended, among others, by the Act of 3 July 2026, Journal of Laws 2026 item 1007, which does not change Articles 18-20), Articles 18, 19, 20 and 61; Regulation (EU) 2016/679 (GDPR), Article 4(1) and (15), Article 5(1)(c) and (e), Article 13(1) and Article 28; information from the Ministry of Health page on survey templates (gov.pl, checked on 2 November 2026). We did not check: the content of the questions in the ministry templates, requirements of particular NFZ branches regarding surveys in rehabilitation practices, provisions on electronic communication, the Act on patient rights as regards complaints, or penalties for lacking an internal system.

Last reviewed: 2 November 2026

If the survey is to be named, or you send it to patients, you need your GDPR documents in order. The PREMIUM package contains templates of an information clause, a record of processing activities and a processing agreement. See the PREMIUM package or compare all packages.

Related articles:
- The healthcare quality Act: internal quality system at a practice
- Adverse events register in physiotherapy
- Complaints about physiotherapy services
- SMS and email to patients under GDPR
- Physiotherapy practice marketing and the law