Abstract Background To understand the implementation of the family doctor contract service system in China from the perspective of resident demand. Methods A stratified random sampling design was employed to survey 6380 residents across the eastern, central, and western regions of China. Data were processed using SPSS 22.0 and Python, and statistical methods such as chi-square and rank sum tests were applied. Multivariate logistic regression analysis was used to assess the impact of various factors. Results (i) Overall implementation of the family doctor contract service system in China: (a) Nationwide awareness rate was 64.73%, with a contracting rate of 12.98%. (b) The overall satisfaction score for the implementation of contracted services was 3.78 out of 5, indicating general satisfaction. (ii) Regional implementation of the family doctor contract service system in the eastern, central, and western regions: (a) Awareness in the eastern region (67.76%) was higher than the national average (64.73%), while it was lower in the central region (60.44%). (b) The contracting rate in the eastern region (15.02%) was also above the national average, with the western region having the lowest rate (12.28%) but the highest willingness to contract. Conclusion The current state of implementation of China’s family doctor contract service system is far from the goals set out in the “Guidance on Promoting High-Quality Development of Family Doctor Contract Services”. Inadequate promotion of the system and subpar service quality post-contract have led to low public trust and satisfaction. The construction of family doctor teams and the contract service guarantee mechanism remain underdeveloped.