A healthcare Net Promoter Score (NPS) survey — ask the classic 0–10 “would you recommend?” plus a reason prompt, and get a promoter / passive / detractor split ready to trend by clinician, department or location.
Quick answer
A healthcare NPS survey captures the classic 0–10 “would you recommend?” question plus a reason, and rolls results into promoters, passives and detractors for trend analysis.
Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified clinician before making care decisions.
NPS is not perfect, but it is a fast, comparable advocacy metric patients actually answer. This survey captures the classic 0–10 “would you recommend?” plus a reason and a follow-up offer. Detractors (0–6) are auto-routed for follow-up; promoters (9–10) can be invited for reviews or referrals. Score, split and reason are all exportable.
Try the actual running form — not a screenshot — before you copy it.
Everything you need to run this template.
From copy to deliverable in four steps.
Copy the form and its branding settings into your FormLM workspace — free; you can upgrade to a scored assessment with an AI PDF report any time.
Adjust fields, options and consent language to match your clinic workflow.
Send the link or QR; every response is captured automatically.
Export or review the collected responses at any time from one dashboard.
Pick your role — see how it fits your clinic workflow.
Track advocacy over time; act on detractors immediately.
Compare NPS across locations and services.
Promoter prompts drive reviews and referral loops.
What makes this template work as a professional clinical deliverable.
A preview of real fields patients see — the full version is a live form — responses are captured automatically and can be exported at any time.
