Appointment Experience Survey
This comprehensive appointment feedback form helps healthcare practices understand the complete patient experience. From scheduling ease to provider interaction, the form captures insights about wait times, staff friendliness, care quality, and facility cleanliness. The conditional logic adapts based on responses, diving deeper into areas of concern while celebrating positive experiences.
Try the Form
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export function appointmentFeedbackSurvey(form: FormTs) {
// Appointment Experience Survey - Healthcare Feedback
// Demonstrates: StarRating, RatingScale (CES), EmojiRating, MatrixQuestion, Slider, Integer, Dropdown, ThumbRating
// ============================================
// HEADER
// ============================================
form.addRow(row => {
row.addTextPanel('header', {
label: 'How Was Your Visit?',
computedValue: () => 'Your feedback helps us provide better care. This survey takes about 2 minutes.',
customStyles: {
backgroundColor: '#0d9488',
color: 'white',
padding: '24px',
borderRadius: '12px',
textAlign: 'center'
}
});
});
// ============================================
// SECTION 1: Appointment Details
// ============================================
const detailsSection = form.addSubform('detailsSection', {
title: 'Appointment Details'
});
detailsSection.addRow(row => {
row.addDropdown('appointmentType', {
label: 'What type of appointment was this?',
options: [
{ id: 'routine', name: 'Routine Checkup' },
{ id: 'followup', name: 'Follow-up Visit' },
{ id: 'new-issue', name: 'New Health Concern' },
{ id: 'specialist', name: 'Specialist Consultation' },
{ id: 'procedure', name: 'Procedure/Treatment' },
{ id: 'telehealth', name: 'Telehealth/Virtual Visit' },
{ id: 'other', name: 'Other' }
],
placeholder: 'Select appointment type...'
});
});
detailsSection.addRow(row => {
row.addThumbRating('firstVisit', {
label: 'Was this your first visit to our practice?',
size: 'md',
showLabels: true,
upLabel: 'Yes, first time',
downLabel: 'No, returning patient',
alignment: 'left'
});
});
// ============================================
// SECTION 2: Scheduling & Arrival
// ============================================
const schedulingSection = form.addSubform('schedulingSection', {
title: 'Scheduling Experience',
isVisible: () => detailsSection.dropdown('appointmentType')?.value() !== null
});
schedulingSection.addRow(row => {
row.addRatingScale('schedulingEase', {
label: 'How easy was it to schedule your appointment?',
preset: 'ces',
size: 'md',
alignment: 'center'
});
});
schedulingSection.addRow(row => {
row.addRadioButton('schedulingMethod', {
label: 'How did you schedule?',
options: [
{ id: 'phone', name: 'Phone call' },
{ id: 'online', name: 'Online portal' },
{ id: 'app', name: 'Mobile app' },
{ id: 'in-person', name: 'In person' },
{ id: 'referral', name: 'Provider referral' }
],
orientation: 'horizontal'
});
});
// ============================================
// SECTION 3: Wait Time
// ============================================
const waitSection = form.addSubform('waitSection', {
title: 'Wait Time',
isVisible: () => detailsSection.dropdown('appointmentType')?.value() !== null &&
detailsSection.dropdown('appointmentType')?.value() !== 'telehealth',
customStyles: () => {
const wait = waitSection.integer('waitMinutes')?.value();
if (wait && wait <= 10) return { backgroundColor: '#d1fae5', padding: '16px', borderRadius: '8px' };
if (wait && wait >= 30) return { backgroundColor: '#fee2e2', padding: '16px', borderRadius: '8px' };
return { padding: '16px', borderRadius: '8px', border: '1px dashed #cbd5e1' };
}
});
waitSection.addRow(row => {
row.addInteger('waitMinutes', {
label: 'Approximately how long did you wait past your scheduled time? (in minutes)',
min: 0,
max: 120,
step: 5,
placeholder: 'Enter minutes...'
});
});
waitSection.addRow(row => {
row.addTextPanel('waitFeedback', {
computedValue: () => {
const wait = waitSection.integer('waitMinutes')?.value();
if (wait === 0) return '🎯 Perfect! Seen right on time.';
if (wait && wait <= 10) return '✅ That\'s a reasonable wait time.';
if (wait && wait <= 20) return '⏱️ Thanks for your patience.';
if (wait && wait <= 30) return '😕 We apologize for the delay.';
if (wait && wait > 30) return '😔 We\'re sorry for the long wait. This shouldn\'t happen.';
return '';
},
customStyles: { fontStyle: 'italic', textAlign: 'center', padding: '8px' },
isVisible: () => waitSection.integer('waitMinutes')?.value() !== null
});
});
waitSection.addRow(row => {
row.addSlider('waitAcceptability', {
label: 'How acceptable was the wait time?',
min: 1,
max: 5,
step: 1,
showValue: true,
defaultValue: 3,
isVisible: () => {
const wait = waitSection.integer('waitMinutes')?.value();
return wait !== null && wait !== undefined && wait > 0;
}
});
});
// ============================================
// SECTION 4: Staff Experience
// ============================================
const staffSection = form.addSubform('staffSection', {
title: 'Staff & Facility',
isVisible: () => detailsSection.dropdown('appointmentType')?.value() !== null
});
staffSection.addRow(row => {
row.addMatrixQuestion('staffRatings', {
label: 'Please rate our staff and facility:',
rows: [
{ id: 'front-desk', label: 'Front desk/reception', isRequired: true },
{ id: 'nursing', label: 'Nursing staff', isRequired: false },
{ id: 'cleanliness', label: 'Facility cleanliness', isRequired: true },
{ id: 'comfort', label: 'Waiting area comfort', isRequired: false },
{ id: 'privacy', label: 'Privacy & confidentiality', isRequired: false }
],
columns: [
{ id: 'poor', label: 'Poor' },
{ id: 'fair', label: 'Fair' },
{ id: 'good', label: 'Good' },
{ id: 'excellent', label: 'Excellent' },
{ id: 'na', label: 'N/A' }
],
striped: true,
fullWidth: true
});
});
// ============================================
// SECTION 5: Provider Experience
// ============================================
const providerSection = form.addSubform('providerSection', {
title: 'Your Care Provider',
isVisible: () => detailsSection.dropdown('appointmentType')?.value() !== null,
customStyles: () => {
const rating = providerSection.starRating('providerRating')?.value();
if (rating && rating >= 4) return { backgroundColor: '#d1fae5', padding: '16px', borderRadius: '8px' };
if (rating && rating <= 2) return { backgroundColor: '#fee2e2', padding: '16px', borderRadius: '8px' };
return { padding: '16px', borderRadius: '8px', border: '1px dashed #cbd5e1' };
}
});
providerSection.addRow(row => {
row.addStarRating('providerRating', {
label: 'How would you rate your care provider?',
maxStars: 5,
size: 'xl',
alignment: 'center',
showConfettiOnMax: true
});
});
providerSection.addRow(row => {
row.addMatrixQuestion('providerAttributes', {
label: 'Please rate your provider on:',
rows: [
{ id: 'listening', label: 'Listened to my concerns', isRequired: true },
{ id: 'explaining', label: 'Explained things clearly', isRequired: true },
{ id: 'time', label: 'Spent adequate time with me', isRequired: false },
{ id: 'respect', label: 'Treated me with respect', isRequired: false },
{ id: 'involvement', label: 'Involved me in decisions', isRequired: false }
],
columns: [
{ id: 'strongly-disagree', label: 'Strongly Disagree' },
{ id: 'disagree', label: 'Disagree' },
{ id: 'neutral', label: 'Neutral' },
{ id: 'agree', label: 'Agree' },
{ id: 'strongly-agree', label: 'Strongly Agree' }
],
striped: true,
fullWidth: true,
isVisible: () => providerSection.starRating('providerRating')?.value() !== null
});
});
// ============================================
// SECTION 6: Overall Experience
// ============================================
const overallSection = form.addSubform('overallSection', {
title: 'Overall Experience',
isVisible: () => providerSection.starRating('providerRating')?.value() !== null
});
overallSection.addRow(row => {
row.addEmojiRating('overallMood', {
label: 'Overall, how did you feel about your visit?',
preset: 'satisfaction',
size: 'lg',
alignment: 'center'
});
});
overallSection.addRow(row => {
row.addThumbRating('wouldReturn', {
label: 'Would you return to our practice for future care?',
size: 'lg',
showLabels: true,
upLabel: 'Yes, definitely',
downLabel: 'Probably not',
alignment: 'center',
isVisible: () => overallSection.emojiRating('overallMood')?.value() !== null
});
});
// ============================================
// SECTION 7: Concerns & Improvements
// ============================================
const concernsSection = form.addSubform('concernsSection', {
title: 'Help Us Improve',
isVisible: () => {
const mood = overallSection.emojiRating('overallMood')?.value();
const provider = providerSection.starRating('providerRating')?.value();
return (mood === 'very-bad' || mood === 'bad' || mood === 'neutral') ||
(provider !== null && provider !== undefined && provider <= 3);
},
customStyles: { backgroundColor: '#fef3c7', padding: '16px', borderRadius: '8px' }
});
concernsSection.addRow(row => {
row.addCheckboxList('concernAreas', {
label: 'What areas need improvement? (select all that apply)',
options: [
{ id: 'wait-time', name: 'Wait time too long' },
{ id: 'scheduling', name: 'Scheduling difficulties' },
{ id: 'communication', name: 'Communication issues' },
{ id: 'staff-attitude', name: 'Staff attitude' },
{ id: 'provider-time', name: 'Not enough time with provider' },
{ id: 'facility', name: 'Facility issues' },
{ id: 'billing', name: 'Billing/insurance confusion' },
{ id: 'follow-up', name: 'Follow-up care unclear' }
],
orientation: 'vertical'
});
});
concernsSection.addSpacer();
concernsSection.addRow(row => {
row.addTextarea('improvementDetails', {
label: 'Please share more details about your concerns:',
placeholder: 'Your feedback helps us improve care for all patients...',
rows: 3
});
});
// ============================================
// SECTION 8: Positive Feedback (for good ratings)
// ============================================
const praiseSection = form.addSubform('praiseSection', {
title: 'What Went Well',
isVisible: () => {
const mood = overallSection.emojiRating('overallMood')?.value();
const provider = providerSection.starRating('providerRating')?.value();
return (mood === 'good' || mood === 'excellent') &&
(provider !== null && provider !== undefined && provider >= 4);
},
customStyles: { backgroundColor: '#ecfdf5', padding: '16px', borderRadius: '8px' }
});
praiseSection.addRow(row => {
row.addTextarea('positiveComments', {
label: 'What made your experience positive?',
placeholder: 'We love hearing what we did well!',
rows: 2
});
});
// ============================================
// SECTION 9: Summary
// ============================================
const summarySection = form.addSubform('summary', {
title: 'Visit Summary',
isVisible: () => overallSection.emojiRating('overallMood')?.value() !== null
});
summarySection.addRow(row => {
row.addTextPanel('summaryContent', {
computedValue: () => {
const appointmentType = detailsSection.dropdown('appointmentType')?.value();
const schedulingEase = schedulingSection.ratingScale('schedulingEase')?.value();
const waitTime = waitSection.integer('waitMinutes')?.value();
const providerRating = providerSection.starRating('providerRating')?.value();
const overallMood = overallSection.emojiRating('overallMood')?.value();
const wouldReturn = overallSection.thumbRating('wouldReturn')?.value();
let summary = '🏥 Appointment Feedback Summary\n';
summary += '━'.repeat(30) + '\n\n';
// Appointment type
if (appointmentType) {
const typeLabels: Record<string, string> = {
'routine': 'Routine Checkup',
'followup': 'Follow-up Visit',
'new-issue': 'New Health Concern',
'specialist': 'Specialist Consultation',
'procedure': 'Procedure/Treatment',
'telehealth': 'Telehealth Visit',
'other': 'Other'
};
summary += `📋 Visit Type: ${typeLabels[appointmentType] || appointmentType}\n`;
}
// Scheduling ease
if (schedulingEase) {
const easeLevel = schedulingEase >= 6 ? 'Easy' : schedulingEase >= 4 ? 'Moderate' : 'Difficult';
summary += `📅 Scheduling: ${easeLevel} (${schedulingEase}/7)\n`;
}
// Wait time
if (waitTime !== null && waitTime !== undefined) {
const waitEmoji = waitTime <= 10 ? '✅' : waitTime <= 20 ? '⏱️' : '⚠️';
summary += `${waitEmoji} Wait Time: ${waitTime} minutes\n`;
}
summary += '\n';
// Provider
if (providerRating) {
summary += `👨⚕️ Provider: ${'⭐'.repeat(providerRating)}${providerRating}/5\n`;
}
// Overall
if (overallMood) {
const moodLabels: Record<string, string> = {
'very-bad': '😢 Very Unsatisfied',
'bad': '😕 Unsatisfied',
'neutral': '😐 Neutral',
'good': '🙂 Satisfied',
'excellent': '😊 Very Satisfied'
};
summary += `\n${moodLabels[overallMood] || overallMood}\n`;
}
// Would return
if (wouldReturn === 'up') {
summary += '✅ Would return';
} else if (wouldReturn === 'down') {
summary += '❌ May not return';
}
return summary;
},
customStyles: () => {
const mood = overallSection.emojiRating('overallMood')?.value();
const baseStyles = {
padding: '16px',
borderRadius: '8px',
whiteSpace: 'pre-wrap',
fontFamily: 'monospace',
fontSize: '14px'
};
if (mood === 'good' || mood === 'excellent') {
return { ...baseStyles, backgroundColor: '#d1fae5', borderLeft: '4px solid #10b981' };
} else if (mood === 'very-bad' || mood === 'bad') {
return { ...baseStyles, backgroundColor: '#fee2e2', borderLeft: '4px solid #ef4444' };
}
return { ...baseStyles, backgroundColor: '#fef3c7', borderLeft: '4px solid #f59e0b' };
}
});
});
// ============================================
// FORM CONFIGURATION
// ============================================
form.configureSubmitButton({
label: 'Submit Feedback',
isVisible: () => overallSection.emojiRating('overallMood')?.value() !== null
});
form.configureCompletionScreen({
type: 'text',
title: 'Thank You for Your Feedback!',
message: 'Your input helps us improve the care we provide to all patients. If you have any immediate concerns, please contact our office directly. We appreciate you trusting us with your healthcare.'
});
}
Frequently Asked Questions
When should I send this survey?
Send within 24-48 hours after the appointment while the experience is fresh. Same-day for routine visits, or a day later for more complex appointments.
How do I address wait time complaints?
Analyze patterns in feedback to identify bottlenecks. Consider scheduling adjustments, patient communication about delays, or process improvements.
Is this HIPAA compliant?
The form itself doesn't collect PHI. Ensure your survey platform and data handling comply with HIPAA requirements for patient communications.
What's a good patient satisfaction target?
Industry benchmarks suggest 85%+ satisfaction is good, 90%+ is excellent. Focus on consistent improvement rather than just hitting a number.
Can I customize for different appointment types?
Yes, the form can be adapted for different visit types - routine checkups, specialist consultations, procedures, or telehealth appointments.