Count it towards your five pieces of feedback
A set of patient responses on your care is practice-related feedback for NMC revalidation. Keep the report as your note of the feedback, alongside what you learned from it.
PATIENT FEEDBACK FOR NURSING REVALIDATION TEMPLATE
Patient feedback for your NMC revalidation.
NMC revalidation asks nurses, midwives and nursing associates for five pieces of practice-related feedback every three years. This template gives you a short, respectful patient feedback form that asks about the things patients notice most, and nothing that identifies them.
Free plan available. No card required.What this form is for
Feedback for revalidation can come from many places: colleagues, students, managers, complaints and compliments. Feedback from the people you care for is often the most meaningful, and the hardest to collect. A short, anonymous form that patients or families can fill in on their phone makes it much easier.
The questions follow what patients consistently say matters to them: being treated with kindness and respect, being listened to, having things explained clearly, and being involved in decisions. Those map naturally onto the themes of the NMC Code, which makes the feedback straightforward to write up in a reflective account.
The form does not ask for names, dates of birth, conditions or anything else that could identify a patient. The NMC is clear that the records you keep for revalidation must not contain identifiable information about patients or colleagues, so the template is built that way from the start.
The questions, and why they’re there
7 questions · every one can be edited- 01
Who is answering?
Multiple choice · The patient · A family member or carer · Someone else
Why it’s asked. Family and carers notice different things from patients. Knowing who answered helps you read the comments in context.
- 02
I was treated with kindness and respect.
1 is strongly disagree, 5 is strongly agree.
Rating, 1–5
Why it’s asked. Dignity and compassion are what patients notice first, and they sit at the heart of the Code.
- 03
I felt listened to.
1 is strongly disagree, 5 is strongly agree.
Rating, 1–5
Why it’s asked. Feeling heard is one of the strongest drivers of how patients judge their care.
- 04
Things were explained in a way I could understand.
1 is strongly disagree, 5 is strongly agree.
Rating, 1–5
Why it’s asked. Clear communication is a core part of practising effectively, and a common theme in complaints when it goes wrong.
- 05
Were you involved in decisions about your care as much as you wanted?
Multiple choice · Yes, definitely · To some extent · No
Why it’s asked. Shared decision making is easy to overlook in a busy shift. A simple three-way answer is quick to give and easy to compare over time.
- 06
What did I do well?
Please don’t include names or personal details.
Long text
Why it’s asked. Specific positive comments are what make a reflective account vivid, and what is most rewarding to read back.
- 07
Is there anything I could do better?
Please don’t include names or personal details.
Long text
Why it’s asked. The constructive comments are what turn feedback into learning — and the part reflective accounts are really about.
What you can do with the results
When the form closes — on a date you set, or when you close it — BetterForms writes the report for you: a chart for every question and every written answer, plus themes and an executive summary on plans that include analysis. Print it or save it as a PDF, share a read-only link, or export the raw responses to CSV or Google Sheets. Here is what people do with it.
Write a reflective account
Pick a theme from the comments, link it to one of the four themes of the Code — prioritise people, practise effectively, preserve safety, promote professionalism and trust — and write about what you will keep doing or change. The ratings give you something concrete to anchor it to.
Take it to your reflective discussion
Bring the report to your reflective discussion with another NMC registrant. Real comments from patients make for a much more useful conversation than recollections.
Use it in appraisal
The same report works as evidence in your annual appraisal or personal development review, and as a starting point for agreeing development goals.
Keep it safely
Save the report as a PDF in your revalidation portfolio. It contains ratings and comments only, with no names or details that identify the people who answered.
Getting good responses
- Check your organisation’s policy on collecting patient feedback, and let your manager know before you start.
- Ask a colleague or the ward clerk to hand out the QR code card, so patients don’t feel they are rating you to your face.
- Offer it near the end of an episode of care, when patients have a full picture of it.
- If a comment raises a concern about care, act on it through your usual local process. Don’t just file it.
Questions
- Does this meet the NMC’s requirements?
- The NMC asks for five pieces of practice-related feedback over three years and is flexible about where it comes from. Patient feedback collected with this form can be one or more of those pieces. Always check the NMC’s current revalidation guidance for the detail.
- Do I send the feedback to the NMC?
- No. You keep a note of the feedback and how you used it in your own portfolio. Your confirmer may want to see it, which is one reason to keep identifiable information out of it.
- Can midwives and nursing associates use it?
- Yes. Revalidation applies to nurses, midwives and nursing associates in the same way. Reword the questions if they don’t quite fit your setting.
- What if a patient includes their name anyway?
- The form asks them not to. If someone does, remove the detail before saving the report to your portfolio.
Start with this template
It opens in the editor as your own form. Change any question, then share it with a link or a QR code. Or start from a blank form and let AI draft the questions for you.
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