Healthcare
Clinic Appointment Request
Request a clinic visit with one question at a time.
Why use this template
A five page survey gets abandoned. This feedback form asks one thing at a time: which location, how the wait felt, how the front desk treated them, and whether they would come back. The note is about the visit experience. Name and email are optional, so people can answer without starting a long thread. Customize the locations and publish the link in your follow up email.
Part of Formgrid’s healthcare form templates workflow for organised enquiries and lead capture.
- Wait, front desk, and facility on separate screens
- A would you return question
- Optional name and email
- Experience notes only, with a confirmation step
What this template collects
- Location visited
- How the wait felt
- Front desk rating
- Building and waiting area
- Whether they would return
- Optional experience note
- Optional name and email
Who this template is for
Clinics that want a short note about the visit experience after someone leaves.
Formgrid features included
- One question on each screen, with a welcome page and a thank you page
- Email notification when a request arrives
- Lead pipeline with New, Contacted, and Converted
- Spam protection on every submission
- Shareable link, or embed the form on your website
- Free to customize. No code required
How it works
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1
Open the live preview and walk through the questions.
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2
Choose Customize Free and edit the wording, colors, and fields.
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3
Publish a link or embed the form on your clinic website.
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4
Each submission lands in Formgrid so your team can follow up.
Live preview
Click through the form, then customize the questions for your own copy.
Frequently asked questions
Is this a clinical outcome survey?
No. It asks about the wait, the front desk, and the building.
Can feedback be anonymous?
Yes. Name and email are optional in the starter form.
Where do the responses go?
They appear in Formgrid, and you can get an email for each one.