Medical Home Patient-Centered Care Survey

Measure and Improve Patient-Centered Medical Home Quality

Understanding your patients' experiences with your medical home practice is essential for delivering truly patient-centered care. This Medical Home Patient-Centered Care Survey template helps healthcare organizations evaluate the core pillars of the Patient-Centered Medical Home model: personalized care planning, self-management support, care team accessibility, and whole-person orientation.

Whether you're a primary care practice seeking PCMH recognition, a community health center measuring quality improvement initiatives, or a health system evaluating care coordination effectiveness, this survey template provides structured insights into what matters most—your patients' experiences and outcomes.

Why This Template Works for Healthcare Providers

Built specifically for primary care practices, community health centers, integrated care teams, and health systems implementing or maintaining PCMH standards, this template addresses the five core attributes of patient-centered care: comprehensive care, patient-centered approach, coordinated care, accessible services, and quality and safety.

The survey covers critical touchpoints including care plan development and personalization, self-management goal setting and support, care team communication and accessibility, coordination across specialists and services, and the practice's attention to physical, mental, and social health needs.

Streamline Feedback and Drive Quality Improvement

With Paperform's conditional logic, you can tailor follow-up questions based on patient responses, ensuring you gather meaningful detail where it matters most. Patients who report challenges accessing their care team can provide specific feedback about barriers, while those with complex conditions can share insights about care coordination across multiple providers.

The form's professional, accessible design ensures patients of all backgrounds and health literacy levels can easily share their experiences. Use Stepper to automatically route survey results to quality improvement teams, trigger follow-up workflows for patients reporting concerns, or compile monthly dashboards that track PCMH performance metrics over time.

Turn Patient Insights Into Better Care

Results from this survey can inform quality improvement initiatives, support PCMH recognition applications, identify training needs for care teams, and most importantly, help you deliver more personalized, coordinated, and accessible care. With Paperform's built-in AI Insights, you can quickly identify themes across hundreds of responses, spot trends in patient satisfaction, and generate actionable recommendations for your practice.

This template is trusted by primary care practices, federally qualified health centers, and integrated care teams committed to measuring and improving the patient experience. Start gathering meaningful feedback today and transform your practice into a truly patient-centered medical home.