Mystery Patient Questionnaire for Clinics
- Who checks
- Mystery patient: an external evaluator or an employee from another clinic in the group
- When
- 1–2 visits per clinic per month, on different weekdays and at different times
- Time
- ~60 min · 28 items
| Location | Date and time | Inspector | Signature |
A mystery patient evaluates what a patient sees and feels: how easy it is to book, how long the wait is, whether they were told what would happen and what it would cost, and whether the bill matched what was promised. The questionnaire does not assess the quality of diagnosis or treatment — that is a job for clinical peer review, not an evaluator without medical training.
Choose a simple, genuine reason for the visit — a consultation or a routine check-up, with no unnecessary procedures. Fill in the form right after leaving the clinic while the details are fresh, and note times by the clock. Review results with the clinic manager and, if needed, with the doctor — without identifying the specific visit if the program is ongoing.
Phone call and booking
-
1
The call was answered by the third ring or returned within 15 minutes Note the time of the call and the answer; if you had to call back, mark "no."☐ Yes☐ No
-
2
The receptionist asked about the reason for the visit and suggested a suitable specialist At least one clarifying question about the reason for the visit; not "I'll book you with whoever you like."☐ Yes☐ No
-
3
At least two date or time options were offered The receptionist suggested options rather than asking "when suits you?"☐ Yes☐ No
-
4
The price of the appointment was given when booking A specific price or range was stated along with what it includes; you didn't have to ask twice.☐ Yes☐ No
-
5
You were told the address, how to get there and what to bring A landmark or entrance, parking availability, ID needed for registration, results of previous tests.☐ Yes☐ No
-
6
You received a reminder the day before the visit A call or message with the date, time and address.☐ Yes☐ No
Arrival and front desk
-
7
The clinic entrance is easy to find and signs lead to reception The sign is visible from the street; inside you didn't have to ask where to go.☐ Yes☐ No
-
8
Wait time at the reception desk, minutes From reaching the desk or the line to the start of service.
-
9
The receptionist greeted you and introduced themselves or wore a name badge The receptionist greeted you first, and you could find out their name.☐ Yes☐ No
-
10
Forms to sign were explained and you were given time to read them The receptionist said what the documents were and didn't rush you with "sign here and here."☐ Yes☐ No
-
11
No other patients' names or diagnoses were spoken aloud in the waiting area Mark "no" if you heard staff say another patient's name together with a service or complaint.☐ Yes☐ No
-
12
The waiting area and restroom are clean No litter in the waiting area or stains on the seats; the restroom has soap, toilet paper and towels.☐ Yes☐ No
Waiting for the appointment
-
13
Actual delay from the booked time, minutes From the booked time to being called in; enter 0 if you were called on time.
-
14
The doctor called you in no later than 10 minutes after the booked time A typical service benchmark; if the clinic has a different standard, use that.☐ Yes☐ No
-
15
You were told about the delay before you had to ask If there was no delay, mark "yes."☐ Yes☐ No
Appointment with the specialist
-
16
The doctor greeted you and introduced themselves They gave their name or wore a visible badge and addressed you by name.☐ Yes☐ No
-
17
Before the examination, the doctor sanitized their hands or put on new gloves in front of you Mark only what you actually saw; if there was no examination, mark "yes."☐ Yes☐ No
-
18
The door stayed closed during the appointment and nobody walked in If someone came in, the doctor asked them to wait or the interruption lasted no more than a minute.☐ Yes☐ No
-
19
The doctor explained the next steps in plain language You can retell in your own words what to do next; the doctor answered your questions without brushing them off.☐ Yes☐ No
-
20
The price of additional services was given before they were performed If tests or procedures beyond the consultation were offered, the price was stated and your consent obtained before starting.☐ Yes☐ No
-
21
You were asked to sign informed consent before any procedure Only if a procedure was performed; the form and requirement follow the rules in your country. If there were no procedures, mark "yes."☐ Yes☐ No
-
22
Recommendations were given in writing A written summary was handed to you or posted to the patient portal, not just explained verbally.☐ Yes☐ No
Payment and end of visit
-
23
The amount charged matched what you were quoted when booking and during the appointment Compare the receipt with the prices given by the receptionist and doctor; no unexpected items.☐ Yes☐ No
-
24
You received a receipt itemizing the services provided The receipt or an attachment shows exactly what you paid for.☐ Yes☐ No
-
25
You were offered a follow-up booking if the doctor recommended one The receptionist suggested a date; if no follow-up was recommended, mark "yes."☐ Yes☐ No
-
26
Staff said goodbye and invited you to leave feedback You were thanked and asked to rate the visit verbally, on a form or via a link.☐ Yes☐ No
-
27
Total visit time from entry to exit, minutes Record it by the clock.
-
28
What did you like most and what got in the way Free comment: 2–3 specific moments, with staff names if you remember them.
This template is a starting point. Check the limits and wording against your local regulations, your company standards and the equipment manufacturers' instructions.
jeCheck · https://jecheck.io/en/templates/clinic-mystery-patient
Common violations
- The price of additional tests is only mentioned at checkout — the patient feels they were upsold, even if the tests were justified, and leaves with a complaint.
- The receptionist calls patients from the hallway by surname and procedure — everyone in the waiting area learns who is seeing which doctor.
- Recommendations are given only verbally — the patient forgets half of them, calls the clinic again or goes to another doctor.
- Nobody explains a 30-minute delay — to the patient it looks like disrespect, even if the doctor was held up for a good reason.
Frequently asked questions
Only the service side: whether the doctor introduced themselves, explained things clearly, stated prices and followed hand hygiene in front of the patient. Whether the diagnosis and treatment were correct is checked by internal or external clinical quality review.
An external agency or employees from another clinic in the group who are not known by sight at the clinic being evaluated. The reason for the visit should be genuine and simple so as not to waste the doctor's time on unnecessary procedures.
Tell them the mystery patient program exists — yes, it makes debriefs less confrontational. Tell them the dates of specific visits — no, or the results will look better than reality.
Similar templates
Run this inspection on your phone
Move the checklist into jeCheck: photos on every item, tasks for each issue with an owner and a deadline, and location comparison by results.