---
title: Urgent Care Visit Feedback Form Template - Patient Satisfaction Survey | Paperform
description: Professional urgent care feedback form to collect patient insights on wait times, provider attentiveness, diagnosis clarity, and overall satisfaction. Improve care quality with actionable patient feedback.
url: "https://paperform.co/templates/urgent-care-visit-feedback-form"
type: static
generatedAt: "2026-03-28T00:45:28.030Z"
---

[← Back to free form templates](/templates/)    ![Urgent Care Visit Feedback Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/urgent-care-visit-feedback-form.png)
    [Preview](https://_preview.paperform.co/ai-template/urgent-care-visit-feedback-form) [Use this template for free](/create?ai-template=urgent-care-visit-feedback-form)    [Feedback & Evaluation Forms](/templates/category/feedback/) [Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/) [Office Manager](/templates/role/office-manager/)[Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Medical Assistant](/templates/role/medical-assistant/)     About this free form template
### Transform Your Urgent Care Patient Experience with Real-Time Feedback

Running an urgent care clinic means balancing speed with quality care—and the only way to know if you're succeeding is by asking your patients directly. This **Urgent Care Visit Feedback Form** is designed specifically for healthcare facilities that need to capture honest, actionable feedback immediately after each visit.

#### Why This Template Works for Urgent Care Facilities

Urgent care occupies a unique space in healthcare: patients arrive with immediate needs, often anxious or uncomfortable, expecting both quick service and attentive care. This feedback form addresses the specific touchpoints that matter most in urgent care settings—from the moment patients check in to when they leave with their diagnosis and treatment plan.

The template covers:

 - **Wait time assessment** from check-in to seeing a provider
 - **Provider attentiveness and bedside manner** ratings
 - **Diagnosis explanation clarity** to ensure patients understand their condition and next steps
 - **Facility cleanliness and comfort** observations
 - **Overall satisfaction** with the visit
 - **Likelihood to recommend** (NPS scoring) to gauge patient loyalty

#### Built for Healthcare Teams Who Care About Continuous Improvement

Whether you're a standalone urgent care clinic, part of a hospital network, or a growing healthcare practice, patient feedback is essential for quality improvement initiatives, staff training, and compliance documentation. This template makes it easy to:

 - **Identify training opportunities** when provider communication scores are lower than expected
 - **Optimize operations** by tracking wait time complaints and bottlenecks
 - **Recognize high-performing staff** when patients mention team members by name
 - **Address issues proactively** before they become larger reputation problems
 - **Report on patient satisfaction metrics** for accreditation and quality benchmarks

#### Designed for Easy Implementation with Paperform

This urgent care feedback form is built on Paperform, meaning you can customize it to match your clinic's branding, embed it on your website, or share it via QR codes posted in your waiting room or checkout area. You can even send it automatically via text or email after each visit.

**Real-time notifications** mean your clinic manager or patient experience coordinator gets alerts when negative feedback comes in, allowing for immediate follow-up with dissatisfied patients—turning potential complaints into opportunities for recovery.

The conditional logic built into this form means patients who report negative experiences are invited to share more details, while those with positive experiences are gently encouraged to leave public reviews on Google or Healthgrades.

#### Automate Your Patient Feedback Workflow with Stepper

Once you've collected feedback, what happens next? With **[Stepper](https://stepper.io)**, Paperform's AI-native workflow builder, you can automatically:

 - Route negative feedback to your patient relations team for immediate follow-up
 - Send positive feedback summaries to your leadership team weekly
 - Add responses to your patient records in your EHR or practice management system
 - Trigger review requests on Google or Facebook for satisfied patients
 - Create performance reports for providers based on aggregated feedback scores

This means feedback doesn't just sit in a spreadsheet—it actively drives improvements across your clinic.

#### Who This Template Is Perfect For

This urgent care feedback form is ideal for:

 - **Urgent care clinics** of all sizes looking to improve patient satisfaction scores
 - **Healthcare administrators** responsible for quality improvement and patient experience
 - **Medical practice managers** who need data to support operational decisions
 - **Clinic directors** aiming to boost staff morale by recognizing excellent care
 - **Healthcare consultants** implementing patient experience programs for clients

#### Why Paperform for Healthcare Feedback?

Paperform is trusted by healthcare providers worldwide because it combines ease of use with the security and compliance features medical practices need. While Paperform is **SOC 2 Type II compliant** and built with data protection in mind, please note it is **not HIPAA compliant**, so this form should be used for feedback and satisfaction data rather than protected health information (PHI).

The beauty of Paperform is that your front desk staff, patient experience coordinator, or clinic manager can customize this form without any coding knowledge. Need to add a question about your new patient portal? Done. Want to change the rating scale or add your clinic's logo? Just click and type.

#### Get Started in Minutes

Simply use this template as your starting point, customize the questions to reflect your specific services and priorities, and share it with patients immediately after their visit. You'll start collecting valuable insights right away—no IT support required.

Transform patient feedback from an afterthought into a competitive advantage for your urgent care clinic with Paperform.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
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