Laravel Patient Experience Survey Template | FilaForms [ ![Filaforms Logo](https://filaforms.app/logo.svg)FilaForms ](https://filaforms.app) [ Features ](https://filaforms.app#features) [ Pricing ](https://filaforms.app/pricing) [ Blog ](https://filaforms.app/blog) [ Documentation ](https://docs.filaforms.app) [ Try Demo ](https://filaforms.app/login) [ Buy a license ](https://filaforms.app/pricing#plans) [ Features ](https://filaforms.app#features) [ Pricing ](https://filaforms.app/pricing) [ Blog ](https://filaforms.app/blog) [ Documentation ](https://docs.filaforms.app) [ Try Demo ](https://filaforms.app/login) [ Buy a license ](https://filaforms.app/pricing#plans) 1. [Home](https://filaforms.app) 2. / 3. [Form Templates](https://filaforms.app/templates) 4. / 5. Measure how patients experienced their visit, not just outcomes Healthcare template Measure how patients experienced their visit, not just outcomes =============================================================== Import a Laravel patient experience survey for Filament, collect visit feedback, and route low scores to the right care team. [ Open this template in the demo builder ](https://filaforms.app/app/templates/patient-experience-survey) 9 fields, 6 required. Free demo account, no card. Updated September 2, 2026 This Laravel patient experience survey collects structured feedback after a visit. Import it into FilaForms to give patients a clear way to report how access, waiting time, and respectful treatment felt. The imported form gives a clinic portal a field table, settings block, and submission dashboard. Staff can review each response in the application they already use, then act on feedback without moving it into a separate survey service. Patient experience feedback works best when a team defines its review path before publishing the survey. Decide who sees new submissions, what triggers a response, and when a concern needs escalation. A form only produces useful feedback when someone owns the next action. The field table below keeps visit feedback focused on observable parts of the encounter. Patients can describe their experience without being asked to interpret clinical care. That boundary makes responses easier to compare across locations, departments, and time periods. [FilaForms is a Laravel form builder for Filament](/) when you want forms and submissions to remain inside your application. The visual builder lets staff change the imported survey in the panel, while application code can handle the work that follows a submission. Fields in this template (9 fields, 6 required) ------------------------------------------------ Field types used: Date, Select, Radio, Toggle Buttons, Textarea, Toggle. Every field is editable in the builder after import. ### Your Visit Field Type Required Validation Visit Date `visit_date` Date Yes `required` Department `department` Select, 7 options Yes `required` ### Your Experience Field Type Required Validation How easy was it to get an appointment? `access` Radio, 5 options Yes `required` Staff treated me with respect `respect` Radio, 5 options Yes `required` My treatment was explained clearly `explanation` Radio, 5 options Yes `required` Waiting Time `waiting_time` Toggle Buttons, 4 options Yes `required` What Went Well? `went_well` Textarea No none What Should We Improve? `improvements` Textarea No none Contact me about this feedback `follow_up` Toggle No none Route concerns and adapt the survey ----------------------------------- The grouping in the field table helps a patient move from the visit context to the experience of receiving care. Department-level context matters because a long wait at one service point needs a different response from a long wait elsewhere. Keep that context available when a manager reviews a concern. Review waiting-time feedback alongside the operating conditions that explain it. Appointment volume, unexpected urgent cases, staffing, and check-in bottlenecks can affect a single day. A pattern across repeated submissions is more useful than treating every response as proof of one cause. Respect feedback needs a faster and more careful route. A low score can indicate a communication problem, a conflict, or a patient who needs contact from a patient advocate. Give the advocate the department, waiting-time answer, and respect answer together. That context supports a first review without turning the survey into a medical record. The submission dashboard is the right place for routine review. A manager can examine feedback for one department, identify recurring concerns, and compare it with operational changes. Keep survey responses distinct from staff performance records until a person has reviewed the situation and established what happened. FilaForms emits `FormSubmitted` after a patient submits the form. The listener below reads `department`, `waiting_time`, and `respect` from the submission data. It records low respect scores for the patient advocate review queue and includes the submission identifier for follow-up. Save this listener as `app/Listeners/RouteLowPatientExperienceScore.php`. Laravel 12 discovers listeners in that directory automatically. ``` submission->data; $department = $data['department'] ?? null; $waitingTime = $data['waiting_time'] ?? null; $respect = $data['respect'] ?? null; if (! is_numeric($respect) || (int) $respect > 2) { return; } Log::channel('patient-advocate')->warning('Low patient experience score requires review', [ 'form_id' => $event->form->getKey(), 'submission_id' => $event->submission->getKey(), 'department' => $department, 'waiting_time' => $waitingTime, 'respect' => $respect, ]); } } ``` Configure the `patient-advocate` log channel to send these records to the queue or incident system your care team monitors. Keep the listener focused on routing. A reviewer should decide whether to contact the patient and should record that decision in the appropriate internal workflow. For staff-level feedback, add a `provider_name` code and make the question optional when patients may not know who treated them. Use that variation only when the team can review feedback fairly. A provider name without visit context can produce misleading conclusions. For a fully anonymous version, remove `follow_up`. Explain that staff cannot reply directly when a patient chooses that version. Anonymous feedback can improve candour, but it also prevents a patient advocate from resolving an individual concern through the survey itself. Do not use this template as a clinical outcomes tool or a HIPAA-compliant intake form. It is a satisfaction survey. Sensitive health data still needs its own handling outside this template, including the controls and review process required for that information. Use the survey as one input to service improvement. Look for department-level trends, confirm them with the people who run that part of the visit, and document the change you make. A later set of submissions can show whether the experience shifted after the change. Review the [FilaForms features for Laravel and Filament](/features) when you need conditional questions, multi-step forms, notifications, or submission reporting around this survey. Keep the follow-up process proportional to the concerns your team can receive and resolve. Use this template in your own application ----------------------------------------- With FilaForms installed, one call creates the form with every field, rule, and setting listed above. Then edit it in the builder. ``` use FilaForms\Core\Support\FormTemplates; $form = FormTemplates::createFormFromTemplate('patient-experience-survey'); ``` Template schema (JSON) ``` { "name": "Patient Experience Survey", "description": "Measure care quality across access, staff and outcome", "icon": "heroicon-o-face-smile", "category": "Healthcare", "popularity": "Medium", "sections": [ { "name": "Your Visit", "fields": [ { "label": "Visit Date", "type": "date", "code": "visit_date", "required": true, "width": "50" }, { "label": "Department", "type": "select", "code": "department", "required": true, "options": [ { "value": "General practice" }, { "value": "Dentistry" }, { "value": "Physiotherapy" }, { "value": "Radiology" }, { "value": "Outpatients" }, { "value": "Emergency" }, { "value": "Other" } ], "width": "50" } ] }, { "name": "Your Experience", "fields": [ { "label": "How easy was it to get an appointment?", "type": "radio", "code": "access", "required": true, "options": [ { "value": "Very easy" }, { "value": "Easy" }, { "value": "Neutral" }, { "value": "Difficult" }, { "value": "Very difficult" } ], "width": "50" }, { "label": "Staff treated me with respect", "type": "radio", "code": "respect", "required": true, "options": [ { "value": "Strongly agree" }, { "value": "Agree" }, { "value": "Neutral" }, { "value": "Disagree" }, { "value": "Strongly disagree" } ], "width": "50" }, { "label": "My treatment was explained clearly", "type": "radio", "code": "explanation", "required": true, "options": [ { "value": "Strongly agree" }, { "value": "Agree" }, { "value": "Neutral" }, { "value": "Disagree" }, { "value": "Strongly disagree" } ], "width": "50" }, { "label": "Waiting Time", "type": "toggle-buttons", "code": "waiting_time", "required": true, "options": [ { "value": "Under 15 min" }, { "value": "15-30 min" }, { "value": "30-60 min" }, { "value": "Over an hour" } ], "width": "50" }, { "label": "What Went Well?", "type": "textarea", "code": "went_well", "required": false, "width": "100" }, { "label": "What Should We Improve?", "type": "textarea", "code": "improvements", "required": false, "width": "100" }, { "label": "Contact me about this feedback", "type": "toggle", "code": "follow_up", "required": false, "width": "100" } ] } ] } ``` Frequently asked questions -------------------------- What does this Laravel patient experience survey collect? It collects structured feedback after a visit, so a clinic can review access, waiting time, and respectful treatment in its own application. What happens after a patient submits the survey? The submission appears in the dashboard, and a Laravel listener can route low respect scores to a patient advocate for review. Can I use the survey to rate individual staff? Yes. Add a provider\_name code when staff-level feedback supports your review process, or remove follow\_up for a fully anonymous survey. Is this a clinical outcomes or HIPAA-compliant intake form? No. It is a satisfaction survey, not a clinical outcomes tool or a HIPAA-compliant intake form, and sensitive health data needs separate handling outside this template. Run this form inside your Laravel app. -------------------------------------- FilaForms installs as a Filament plugin. Submissions land in your own database. 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